Is anterior cruciate ligament graft rupture (after successful anterior cruciate ligament reconstruction and return to sports) actually a graft failure or a re-injury?

Abstract

The objective of this study is to discuss the fact that whether graft rupture after successful anterior cruciate ligament (ACL) reconstruction surgery is due to graft failure or re-injury to the reconstructed ACL. Methods: In total, 340 sportspersons, meeting our inclusion criteria, were assessed for rupture of ipsilateral ACL graft and ACL injury of the contralateral knee. Patients with ipsilateral ACL graft rupture were labelled as group 1, while those with contralateral ACL injury were labelled as group 2. Both groups were compared for potential risk factors for ACL injury, and statistical analysis was performed to study whether the graft acted as an additional risk factor. Results: Of the 340 sportspersons, 25 patients suffered a total of 26 injuries. Ipsilateral graft rupture rate was 2.4% (8 of 340) at a mean follow-up of 25.5 + 40.57 months, and the contralateral ACL injury rate was 5.3% (18 of 340) at a mean follow-up of 18.11 + 19.97 months, with an overall re-injury rate of 7.6%. Both groups were comparable for risk factors for ACL injury: age (p ¼ 0.255), gender (p ¼ 0.534), mode of re-injury (p ¼ 0.523), level of sports activity, type of graft used (p ¼ 0. 918), graft diameter (p ¼ 0.607), duration from injury to index surgery (p ¼ 0.492), duration from index surgery to re-injury (p ¼ 0.638), timing of return to sports after index surgery (p ¼ 0.303), duration of sporting activity before second injury (p ¼ 0.657), and Tegner's level of sports activity (p ¼ 0.486). Conclusion: Because the rate of contralateral ACL injury is higher than the ipsilateral graft rupture and the risk factors for ACL injury are comparable in both groups at a follow-up period, which is suggestive of ligamentization of the graft, we suggest that it might be an ACL re-injury rather than graft failure.

Does sex affect second ACL injury risk? A systematic review with meta-analysis

“…Seven studies (36.8%) were found to be at high risk of bias. [53][54][55][56][57][58][59] The remaining 12 were determined to be at low (n=11, 57.9%) or moderate (n=1, 5.3%) risk of bias 30 38 60-69 (tables 1A-C).…”

“…Seven studies were excluded from our primary analysis due to high risk of bias. [53][54][55][56][57][58][59] Thus, 12 studies with 2944 participants (females=1431 (48.6%), males=1513 (51.4%)) were included in the primary meta-analyses. 30 38 60-69…”

“…High risk of bias studies were added back into the primary meta-analysis (n=7) [53][54][55][56][57][58][59] to determine the effect and direction of observed bias in the available literature. This sensitivity analysis found no statistically significant difference between sexes in the overall relative risk of sustaining a second ACL injury (RR=0.98, 95% CI 0.81 to 1.18, p=0.799, I 2 =32%).…”

Whole-Body Vibration for Individuals with Reconstructed Anterior Cruciate Ligament: A Systematic Review

“…Injuries in this joint and related structures greatly impair daily activities. The anterior cruciate ligament (ACL) is one of the cruciate ligaments responsible to stabilize the knee [1][2][3] during flexion and extension, in which the ACL and the posterior cruciate ligament act contributing to the prevention of excessive forward or backward movements of the tibia in relation to the femur, and providing rotational stability in the knee [4].…”

Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone Autograft With Suture Tape Augmentation

“…Recent studies have suggested that female individuals are more susceptible, with several potential factors postulated, including weaker hamstrings, increased valgus angulation at the knee, and hormonal influences. 7 Concerns regarding the healing capacity of the ACL led to the development of ACL reconstruction, usually with autograft, as the gold standard for the past 30 years. However, ACL reconstruction does not come without complications, being challenged by residual laxity, variable performance outcomes, rerupture, and donor-site morbidity.…”