Higher risk of contralateral anterior cruciate ligament (ACL) injury within 2 years after ACL reconstruction in under-18-year-old patients with steep tibial plateau slope

Abstract

Purpose To assess the role of Tibial Plateau Slope (TPS) as risk factor for early Anterior Cruciate Ligament (ACL) reconstruction failure and contralateral ACL injury in a population of patients with less than 18 years of age and operated on with the same surgical technique. Methods Ninety-four consecutive patients (mean age 15.7 ± 1.5 years) with at least 2 years of follow-up, who underwent ACL reconstruction with a single-bundle plus lateral-plasty hamstring technique in the same centre were included. Subsequent ACL injuries (ipsilateral ACL revision or contralateral ACL reconstruction) were assessed within the irst 2 years after surgery. Anterior, central, posterior TPS of medial compartment were measured on lateral radiographs and compared between patients with intact graft and those with a second injury. Cut-of values with sensitivity and speciicity were calculated with receiver operating characteristic (ROC) analysis. Survival analysis for second ACL injuries and multivariate analysis were performed. Results Eight patients (9%) had ipsilateral ACL Revision and eight patients (9%) had contralateral ACL reconstruction. Patients with contralateral injury had a higher Central TPS with respect to those without second injury (12.6° ± 2.8° vs 9.3° ± 3.7°, p = 0.042). No diferences were present in patients with ipsilateral ACL revision. Sensitivity and speciicity for central TPS slope ≥ 12° to detect a contralateral rupture were 63% and 75% (p = 0.0092), for Anterior TPS were 100% and 52% (p = 0.0009). Patients with TPS values exceeding these cut-ofs had higher rate of contralateral ACL injuries (19%vs4%, p = 0.0420) and lower 2-year survival (p = 0.0049). Multivariate analysis identiied pre-operative sport level and TPS (either anterior or central) as risk factors for contralateral injuries. Conclusions Steep tibial plateau slope ≥ 12° is associated with a higher risk of contralateral ACL injury within 2 years after ACL reconstruction in patients less than 18 years of age. However, TPS has no role in early ipsilateral re-injury after combined ACL reconstruction and lateral plasty. The clinical relevance is that both the surgeon and the patient should be aware of this higher risk and consider it in the rehabilitation phase to reduce the incidence of such injuries. Level of evidence III.

Spontaneous healing of acute ACL ruptures: rate, prognostic factors and short-term outcome

“…Additionally, this treatment concept would also contains the advantage to reduce other complications as arthrofibrosis, which is less likely with delayed ACL surgery [47,48]. A consideration of the PTS in this context is rational because it was reported as a risk factor for ACL ruptures or re-ruptures in several studies with evidence of high forces on the ligament in individuals with increased PTS values [20,[49][50][51][52].…”

The 25‐year experience of over‐the‐top ACL reconstruction plus extra‐articular lateral tenodesis with hamstring tendon grafts: the story so far

“…Similarly, another report of 54 adolescents at a minimum follow-up of 10 years showed that those positive clinical results are stable over time with only 3.5% of revision rate and an average Lysholm of 95 points [ 50 ]. Finally, Over-the-top with lateral plasty has been reported to be successful also in adolescents with increased tibial slope, which represents a renowned risk factor for ACL reconstruction failure [ 51 ]. In fact, the revision rate in patients with a slope higher than 12° remained significantly lower when compared with the 19% of risk of contralateral ACL injuries [ 51 ].…”

“…Finally, Over-the-top with lateral plasty has been reported to be successful also in adolescents with increased tibial slope, which represents a renowned risk factor for ACL reconstruction failure [ 51 ]. In fact, the revision rate in patients with a slope higher than 12° remained significantly lower when compared with the 19% of risk of contralateral ACL injuries [ 51 ].…”

Can we afford to ignore the biology of joint healing and graft incorporation after ACL reconstruction?

“…It is possible that the relative contributions of graft maturity and neuromuscular recovery to ipsilateral and contralateral second ACL injuries shift over time and differ between patients. While several studies show the risk for contralateral ACL injury exceeds that of ipsilateral graft rupture, 90,91 individual ACL graft biology, and maturation status should also be considered in the development of personalized strategies to reduce reinjury risk (Figure 4).…”