Subsequent Surgery After Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors From a Multicenter Cohort

David Y Ding; Alan L Zhang; Christina R Allen; Allen F Anderson; Daniel E Cooper; Thomas M DeBerardino; Warren R Dunn; Amanda K Haas; Laura J Huston; Brett (Brick) A Lantz; Barton Mann; Kurt P Spindler; Michael J Stuart; Rick W Wright; John P Albright; Annunziato (Ned) Amendola; Jack T Andrish; Christopher C Annunziata; Robert A Arciero; Bernard R Bach; Champ L Baker; Arthur R Bartolozzi; Keith M Baumgarten; Jeffery R Bechler; Jeffrey H Berg; Geoffrey A Bernas; Stephen F Brockmeier; Robert H Brophy; Charles A Bush-Joseph; J. Brad Butler; John D Campbell; James L Carey; James E Carpenter; Brian J Cole; Jonathan M Cooper; Charles L Cox; R. Alexander Creighton; Diane L Dahm; Tal S David; David C Flanigan; Robert W Frederick; Theodore J Ganley; Elizabeth A Garofoli; Charles J Gatt; Steven R Gecha; James Robert Giffin; Sharon L Hame; Jo A Hannafin; Christopher D Harner; Norman Lindsay Harris; Keith S Hechtman; Elliott B Hershman; Rudolf G Hoellrich; Timothy M Hosea; David C Johnson; Timothy S Johnson; Morgan H Jones; Christopher C Kaeding; Ganesh V Kamath; Thomas E Klootwyk; Bruce A Levy; C. Benjamin Ma; G. Peter Maiers; Robert G Marx; Matthew J Matava; Gregory M Mathien; David R McAllister; Eric C McCarty; Robert G McCormack; Bruce S Miller; Carl W Nissen; Daniel F O’Neill; Brett D Owens; Richard D Parker; Mark L Purnell; Arun J Ramappa; Michael A Rauh; Arthur C Rettig; Jon K Sekiya; Kevin G Shea; Orrin H Sherman; James R Slauterbeck; Matthew V Smith; Jeffrey T Spang; Steven J Svoboda; Timothy N Taft; Joachim J Tenuta; Edwin M Tingstad; Armando F Vidal; Darius G Viskontas; Richard A White; James S Williams; Michelle L Wolcott; Brian R Wolf; James J York

doi:10.1177/0363546517707207

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Subsequent Surgery After Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors From a Multicenter Cohort

Journal article

Peer reviewed

Subsequent Surgery After Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors From a Multicenter Cohort

David Y Ding, Alan L Zhang, Christina R Allen, Allen F Anderson, Daniel E Cooper, Thomas M DeBerardino, Warren R Dunn, Amanda K Haas, Laura J Huston, Brett (Brick) A Lantz, …

The American journal of sports medicine, Vol.45(9), pp.2068-2076

07/2017

DOI: 10.1177/0363546517707207

PMCID: PMC5513777

PMID: 28557557

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Abstract

Background: While revision anterior cruciate ligament reconstruction (ACLR) can be performed to restore knee stability and improve patient activity levels, outcomes after this surgery are reported to be inferior to those after primary ACLR. Further reoperations after revision ACLR can have an even more profound effect on patient satisfaction and outcomes. However, there is a current lack of information regarding the rate and risk factors for subsequent surgery after revision ACLR. Purpose: To report the rate of reoperations, procedures performed, and risk factors for a reoperation 2 years after revision ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 1205 patients who underwent revision ACLR were enrolled in the Multicenter ACL Revision Study (MARS) between 2006 and 2011, composing the prospective cohort. Two-year questionnaire follow-up was obtained for 989 patients (82%), while telephone follow-up was obtained for 1112 patients (92%). If a patient reported having undergone subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Multivariate regression analysis was performed to determine independent risk factors for a reoperation. Results: Of the 1112 patients included in the analysis, 122 patients (11%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperations, 27% were meniscal procedures (69% meniscectomy, 26% repair), 19% were subsequent revision ACLR, 17% were cartilage procedures (61% chondroplasty, 17% microfracture, 13% mosaicplasty), 11% were hardware removal, and 9% were procedures for arthrofibrosis. Multivariate analysis revealed that patients aged <20 years had twice the odds of patients aged 20 to 29 years to undergo a reoperation. The use of an allograft at the time of revision ACLR (odds ratio [OR], 1.79; P = .007) was a significant predictor for reoperations at 2 years, while staged revision (bone grafting of tunnels before revision ACLR) (OR, 1.93; P = .052) did not reach significance. Patients with grade 4 cartilage damage seen during revision ACLR were 78% less likely to undergo subsequent operations within 2 years. Sex, body mass index, smoking history, Marx activity score, technique for femoral tunnel placement, and meniscal tearing or meniscal treatment at the time of revision ACLR showed no significant effect on the reoperation rate. Conclusion: There was a significant reoperation rate after revision ACLR at 2 years (11%), with meniscal procedures most commonly involved. Independent risk factors for subsequent surgery on the ipsilateral knee included age <20 years and the use of allograft tissue at the time of revision ACLR.

reoperation

risk factors

revision anterior cruciate ligament reconstruction

outcomes

subsequent surgery

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Title: Subtitle: Subsequent Surgery After Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors From a Multicenter Cohort
Creators: David Y Ding - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Alan L Zhang - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Christina R Allen - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Allen F Anderson - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Daniel E Cooper - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Thomas M DeBerardino - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Warren R Dunn - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Amanda K Haas - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Laura J Huston - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Brett (Brick) A Lantz - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Barton Mann - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Kurt P Spindler - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Michael J Stuart - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Rick W Wright - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
John P Albright - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Annunziato (Ned) Amendola - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Jack T Andrish - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Christopher C Annunziata - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Robert A Arciero - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Bernard R Bach - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Champ L Baker - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Arthur R Bartolozzi - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Keith M Baumgarten - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Jeffery R Bechler - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Jeffrey H Berg - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Geoffrey A Bernas - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Stephen F Brockmeier - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Robert H Brophy - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Charles A Bush-Joseph - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
J. Brad Butler - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
John D Campbell - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
James L Carey - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
James E Carpenter - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Brian J Cole - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Jonathan M Cooper - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Charles L Cox - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
R. Alexander Creighton - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Diane L Dahm - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Tal S David - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
David C Flanigan - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Robert W Frederick - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Theodore J Ganley - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Elizabeth A Garofoli - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Charles J Gatt - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Steven R Gecha - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
James Robert Giffin - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Sharon L Hame - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Jo A Hannafin - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Christopher D Harner - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Norman Lindsay Harris - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Keith S Hechtman - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Elliott B Hershman - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Rudolf G Hoellrich - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Timothy M Hosea - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
David C Johnson - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Timothy S Johnson - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Morgan H Jones - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Christopher C Kaeding - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Ganesh V Kamath - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Thomas E Klootwyk - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Bruce A Levy - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
C. Benjamin Ma - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
G. Peter Maiers - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Robert G Marx - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Matthew J Matava - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Gregory M Mathien - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
David R McAllister - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Eric C McCarty - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Robert G McCormack - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Bruce S Miller - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Carl W Nissen - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Daniel F O’Neill - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Brett D Owens - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Richard D Parker - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Mark L Purnell - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Arun J Ramappa - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Michael A Rauh - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Arthur C Rettig - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Jon K Sekiya - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Kevin G Shea - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Orrin H Sherman - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
James R Slauterbeck - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Matthew V Smith - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Jeffrey T Spang - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Steven J Svoboda - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Timothy N Taft - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Joachim J Tenuta - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Edwin M Tingstad - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Armando F Vidal - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Darius G Viskontas - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Richard A White - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
James S Williams - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Michelle L Wolcott - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Brian R Wolf - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
James J York - Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
Resource Type: Journal article
Publication Details: The American journal of sports medicine, Vol.45(9), pp.2068-2076
DOI: 10.1177/0363546517707207
PMID: 28557557
PMCID: PMC5513777
NLM abbreviation: Am J Sports Med
ISSN: 0363-5465
eISSN: 1552-3365
Publisher: SAGE Publications; Los Angeles, CA
Language: English
Date published: 07/2017
Academic Unit: Orthopedics and Rehabilitation; Physical Therapy and Rehabilitation Science
Record Identifier: 9984040497502771

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