Effect of Graft Choice on the Outcome of Revision Anterior Cruciate Ligament Reconstruction in the Multicenter ACL Revision Study (MARS) Cohort

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

doi:10.1177/0363546514549005

Cited by 223 publications

(82 citation statements)

References 26 publications

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“…Other studies have shown that allografts, particularly fresh frozen, non-irradiated allografts, have similar retear risk as autografts; however, these studies tended to also have a much older patient group in the allograft group 5, 44–51 . In the MARS data 52 when the extent of low dose versus no irradiation in allograft in revision ACLR was examined, the failure rates between the two were no different. This study has demonstrated that a change in a surgeon’s use of allograft to older patients will significantly decrease their failure risk.…”

Section: Discussionmentioning

confidence: 99%

Change in Anterior Cruciate Ligament Graft Choice and Outcomes Over Time

Kaeding

Pedroza

Reinke

et al. 2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Purpose To analyze failure rate in two-year increments to determine if graft choice changed over time and graft failure rate. Methods A prospective 2002–2008 database was used to identify risk factors for anterior cruciate ligament retear (ACLR). Subjects who had primary ACLR with no history of contralateral surgery and 2-year follow-up were included. Subjects who underwent a multi-ligament reconstruction were excluded. Graft type, age, sex, smoking status, body mass index, Marx activity level at index surgery, medial and lateral meniscus status at time of ACLR, sport played post-ACLR, and clinical site were evaluated. Analysis was repeated using 2002–2003 (early) and 2007–2008 (late) two-year databases. ANOVA with post-hoc analysis was performed to detect significant differences in age and Marx score by graft type over time. Results Two-year follow-up for graft failure was obtained on 2497/2692 (93%) subjects. There were 112/2497 (4.5%) ACLRs identified at two-year follow-up. The only predictor that changed between early/late periods was allograft use. Allograft odds ratio decreased from 13.1 to 9.5 (p<.01). Allografts were used in older patients (31–40 years) and with lower Marx scores (10–8) from early to late periods. Mean age of subjects receiving BTB autografts did not significantly change over time (22.8 to 23.5) Mean age of subjects receiving hamstring autografts fell (27.9 to 25.5). Mean age of subjects receiving allografts rose significantly (31.3 to 39.8, p<.01). Mean Marx score of subjects who received BTB and hamstring autografts did not significantly change over time. Mean Marx score of subjects receiving allografts decreased significantly (p<.01). Conclusions After early recognition allograft use in young active patients was a risk factor for retear, graft choice by surgeons changed in the late period to use of allografts in older and less-active patients, which correlated with significant decrease in retear risk. Level of Evidence Therapeutic-III, case control study

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Section: Discussionmentioning

confidence: 99%

Change in Anterior Cruciate Ligament Graft Choice and Outcomes Over Time

Kaeding

Pedroza

Reinke

et al. 2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…Other authors have noted that use of allograft significantly increases the risk for hardware removal reoperations 3 . In a previous MARS group manuscript, allograft was confirmed to have an increased incidence of re-rupture and lower outcome measures 9 . In addition to showing that patients undergoing rACLR using autograft tissue were 2.78 times less likely to sustain a subsequent graft rupture compared to allograft, the group showed that the use of autograft resulted in improved IKDC scores, KOOS sports and recreation and quality of life subscores, as well as increased Marx activity level scores 9 .…”

Section: Discussionmentioning

confidence: 93%

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

David

2017

Am J Sports Med

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Background While revision ACL reconstruction (rACLR) can be performed to restore knee stability and improve patient activity level, outcomes after these surgeries are reported to be inferior to primary ACL reconstruction. Further reoperation after rACLR can have an even more profound effect on patient satisfaction and outcome. However, there is a current lack of information regarding the rate and risk factors for subsequent surgery after rACLR. Purpose To report the rate of reoperation, procedures performed, and risk factors for reoperation two years after rACLR. Study Design Cohort Study, Level of Evidence 2 Methods 1205 patients who underwent rACLR were enrolled in the Multicenter ACL Revision Study (“MARS”) between 2006 and 2011, comprising the prospective cohort. Two-year questionnaire follow-up was obtained on 989 (82%), while telephone follow-up was obtained on 1112 (92%). If a patient reported having a subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Multivariate regression analysis was performed to determine independent risk factors for 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 reoperation procedures, 27% were meniscus procedures (69% meniscectomy, 26% repair), 19% were subsequent rACLR, 17% were cartilage procedures (61% chondroplasty, 17% microfracture, and 13% mosaicplasty), 11% were hardware removal, and 9% were procedures for arthrofibrosis. Multivariate analysis revealed that patients under 20 years old had twice the odds of patients aged 20–29 to have a reoperation. Use of allograft at the time of rACLR (OR 1.79, p=0.007) was a significant predictor for reoperations at 2 years while staged revision (bone grafting of tunnels before rACLR) (OR 1.93, p=0.052) trended toward significance. Patients with grade IV cartilage damage seen during rACLR were 78% less likely to undergo subsequent operations within 2 years. Sex, BMI, smoking history, Marx activity score, technique for femoral tunnel placement and meniscal tear or meniscal treatment at the time of rACLR showed no significant effect on reoperation rate. Conclusion There is a significant reoperation rate following rACLR at two years (11%) with meniscal procedures most commonly involved. Independent risk factors for subsequent surgery on the ipsilateral knee include age<20 years old and use of allograft tissue at the time of rACLR.

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“…16,17 This collaboration consists of a group of 83 sports medicine fellowship trained surgeons at 52 sites. Surgeons are a mix of academic (n=23; 44%) and private practitioners (n=29; 56%).…”

Section: Methodsmentioning

confidence: 99%

Meniscal and Articular Cartilage Predictors of Clinical Outcome After Revision Anterior Cruciate Ligament Reconstruction

Wright¹,

Huston²,

Nwosu³

et al. 2016

Am J Sports Med

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Background Revision anterior cruciate ligament (ACL) reconstruction has been documented to have worse outcomes compared to primary ACL reconstructions. The purpose of this study was to determine if the prevalence, location and/or degree of meniscal and chondral damage noted at the time of revision ACL reconstruction predicts activity level, sports function, and osteoarthritis symptoms at two-year follow-up. Hypothesis The hypothesis is that meniscal loss and high grade chondral damage noted at the time of revision ACL reconstruction will result in lower activity levels, decreased sports participation, more pain, more stiffness and more functional limitation at two years following revision surgery. Study Design Cohort Study; Level of evidence, 2. Methods Between 2006 and 2011, 1205 patients who underwent revision ACL reconstruction by 83 surgeons at 52 hospitals were accumulated for study of the relationship of meniscal pathology and articular cartilage pathology to outcome. Baseline demographic and intraoperative data, including the IKDC subjective knee evaluation, KOOS, WOMAC and Marx activity score were collected initially and at two years follow-up to test the hypothesis. Regression analysis was used to control for age, gender, body mass index, smoking status, activity level, baseline outcome scores, revision number, time since last ACL reconstruction, incidence of having a previous ACL reconstruction on the contralateral knee, previous and current meniscal and articular cartilage pathology, graft choice, and surgeon years of experience, in order to assess the meniscal and articular cartilage pathology risk factors for clinical outcomes two years after revision ACL reconstruction. Results At two years follow-up 82% (989/1205) of the patients returned their questionnaires. It was found that previous meniscal pathology and current articular cartilage pathology were associated with the poorest outcomes, with prior lateral meniscectomy and current grade III–IV trochlear articular cartilage changes having the worst outcome scores. Activity levels at two years were not affected by meniscal or articular cartilage pathology. Conclusions Prior lateral meniscectomy and current grade III–IV changes of the trochlea are associated with worse outcomes in terms of decreased sports participation, more pain, more stiffness and more functional limitation at two years following revision surgery, but had no effect on activity levels. Clinical Relevance This study emphasizes the importance of the lateral meniscus, particularly in the presence of an ACL injury. Preservation of this structure should be one of the highest priorities during reconstructive surgery. Grade III–IV changes in the trochlea also has severe detrimental effects on the outcome of revision ACL reconstruction and measures need to be employed to prevent conditions that bring out deterioration of the trochlear cartilage.

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Effect of Graft Choice on the Outcome of Revision Anterior Cruciate Ligament Reconstruction in the Multicenter ACL Revision Study (MARS) Cohort

Cited by 223 publications

References 26 publications

Change in Anterior Cruciate Ligament Graft Choice and Outcomes Over Time

Change in Anterior Cruciate Ligament Graft Choice and Outcomes Over Time

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

Meniscal and Articular Cartilage Predictors of Clinical Outcome After Revision Anterior Cruciate Ligament Reconstruction

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