Minimizing the risk of graft failure after anterior cruciate ligament reconstruction in athletes. A narrative review of the current evidence

Costa, Giuseppe Gianluca; Perelli, Simone; Grassi, Alberto; Russo, Arcangelo; Zaffagnini, Stefano; Monllau, Juan Carlos

doi:10.1186/s40634-022-00461-3

Cited by 22 publications

(33 citation statements)

References 154 publications

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“…Such knowledge will further facilitate the design of training and rehabilitation protocols aiming at risk reduction for secondary injuries following ACL rupture. Previous narrative [ 15 ] and systematic reviews [ 6 , 14 , 16 – 18 ] on risk factors for graft rupture focus either on specific risk factors, such as sex [ 14 , 17 ], or only include specific subgroups of studies, such as younger participants [ 16 ] or registry studies [ 18 ]. To our knowledge, there are no previous studies synthesizing all risk factors for graft rupture without population restrictions.…”

Section: Introductionmentioning

confidence: 99%

Return to Sports: A Risky Business? A Systematic Review with Meta-Analysis of Risk Factors for Graft Rupture Following ACL Reconstruction

2022

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Background The risk of sustaining a graft rupture after anterior cruciate ligament reconstruction (ACLR) is high. Contributing risk factors are, however, still not clearly identified. Objective The aim of this systematic review was to identify and quantify risk factors for graft rupture after ACLR. Methods A systematic review with meta-analysis (PROSPERO CRD42020140129) based on PRISMA guidelines was performed. MEDLINE, CINAHL and EMBASE were searched from inception to September 2021. Prospective and retrospective studies addressing risk factors for graft rupture after ACLR in males/females of all ages were considered. Meta-analyses using a random effect model (effect measure: odds ratio [OR] with 95% confidence interval [CI]) were performed. The GRADE tool was used to assess evidence quality. Results Following full-text screening of 310 relevant papers, 117 were eventually included, incorporating up to 133,000 individuals in each meta-analysis. Higher Tegner activity level (≥ 7 vs < 7) at primary injury (OR 3.91, 95% CI 1.69–9.04), increased tibial slope (degrees) (OR 2.21, 95% CI 1.26–3.86), lower psychological readiness to return to sport (RTS) (OR 2.18, 95% CI 1.32–3.61), early surgery (< 12 vs ≥ 12 months) (OR 1.87, 95% CI 1.58–2.22), RTS (pre-injury level) (OR 1.87, 95% CI 1.21–2.91) and family history of ACL injury (OR 1.76, 95% CI 1.34–2.31) were all associated with increased odds of graft rupture. Higher age (OR 0.47, 95% CI 0.39–0.59), female sex (OR 0.88, 95% CI 0.79–0.98), fewer self-reported knee symptoms pre-reconstruction (OR 0.81, 95% CI 0.69–0.95) and concomitant cartilage injuries (OR 0.70, 95% CI 0.62–0.79) instead decreased the odds. Meta-analysis revealed no association between body mass index, smoking, joint laxity, RTS time, knee kinematics, muscle strength or hop performance and graft rupture. Conclusion Conspicuous risk factors for graft rupture were mainly sports and hereditary related. Few studies investigated function-related modifiable factors or included sports exposure data.

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Section: Introductionmentioning

confidence: 99%

Return to Sports: A Risky Business? A Systematic Review with Meta-Analysis of Risk Factors for Graft Rupture Following ACL Reconstruction

2022

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“…Moreover, there is no evidence for the use of grafts .10 mm in diameter. 14,15 The mean graft length was significantly shorter (P \ .0001) in the ST group compared with the ST/G group. Furthermore, the mean graft length of female patients in the ST group (70 mm) was smaller than in the male subgroup (80 mm).…”

Section: Discussionmentioning

confidence: 94%

Anterior Cruciate Ligament Reconstruction Using a 4-Strand Semitendinosus Tendon Graft or a Doubled Semitendinosus and Gracilis Tendon Graft: A 4.5-Year Prospective, Randomized, Double-Blind, Parallel-Group Study

et al. 2023

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Background: Hamstring tendon grafts are the most common choice for anterior cruciate ligament (ACL) reconstruction (ACLR). Previous studies have provided evidence that offers conflicting opinions concerning the most favorable graft choice. Purpose: To identify whether the use of a quadrupled semitendinosus tendon (ST) or doubled semitendinosus tendon and gracilis tendon (ST/G) graft provides comparable anterior tibial translation (ATT) with similar functional results and similar donor site morbidity. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This was a prospective, patient- and surgeon-blinded, randomized trial set in a busy orthopaedic and traumatology department at a university hospital. Between 2015 and 2017, a total of 162 patients with ACL lesions were randomized to undergo ACLR with either a quadrupled ST or doubled ST/G graft. The primary endpoint was ATT assessed with the KT-1000 arthrometer. Clinical outcomes were assessed using the patient-reported outcome measures (PROMs) of the visual analog scale (VAS), International Knee Documentation Committee (IKDC) subjective evaluation form, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity scale, and Lysholm knee scoring scale. Results: Preoperative demographic data, ATT, and PROM scores showed no significant differences. At 4.5 years, no significant differences were found between the ST and ST/G groups with respect to PROM scores and KT-1000 arthrometer, Lachman test, and pivot-shift test findings. Differences in functional results between groups were significant (muscle strength). Subgroup analysis revealed significantly increased ATT in female patients undergoing ACLR with a quadrupled ST graft during the 4.5-year observation period, as assessed by the KT-1000 arthrometer, as well as inferior KOOS, IKDC, Lysholm, and VAS scores. Conclusion: This study showed a significant increase in ATT as well as inferior results on PROMs during a 4.5-year observation period in female patients undergoing ACLR with a quadrupled ST graft. In male patients, the study provided evidence of the noninferiority of ACLR with an ST graft, with no influence on donor site morbidity. Trial Registration: clinicaltrials.gov: NCT03626883

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“…The risk of a second ACL tear is significantly reduced when the appropriate treatment is given. A second ACL injury about 20%-35% of patients with an ACL reconstruction (9,19). Also, postponement of RTS by extending rehabilitation to 9 months reduced the reinjury rate by 51% (33).…”

Section: Practical Applicationsmentioning

confidence: 99%

Return to Sport After an Anterior Cruciate Ligament Tear: Bridging the Gap Between Research and Practice

Arias

Monaco

Schöenfeld

2023

Strength &Amp; Conditioning Journal

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An anterior cruciate ligament (ACL) tear is one of the most frequent injuries experienced by athletes of all levels. Because so many variables are at play, there is a great deal of controversy about how and why this occurs. In addition, there are various suggested appropriate steps to take to return to sport in the fastest and safest possible way. However, a major issue in injury recovery and return to sport practices is the lack of a gold-standard method or a consistent course of action that an athlete should undertake after suffering an ACL injury. Therefore, the purpose of this paper is to review the literature to determine evidence-based methods for return to sport after ACL reconstruction and provide practical recommendations to guide the process.

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Minimizing the risk of graft failure after anterior cruciate ligament reconstruction in athletes. A narrative review of the current evidence

Cited by 22 publications

References 154 publications

Return to Sports: A Risky Business? A Systematic Review with Meta-Analysis of Risk Factors for Graft Rupture Following ACL Reconstruction

Return to Sports: A Risky Business? A Systematic Review with Meta-Analysis of Risk Factors for Graft Rupture Following ACL Reconstruction

Anterior Cruciate Ligament Reconstruction Using a 4-Strand Semitendinosus Tendon Graft or a Doubled Semitendinosus and Gracilis Tendon Graft: A 4.5-Year Prospective, Randomized, Double-Blind, Parallel-Group Study

Return to Sport After an Anterior Cruciate Ligament Tear: Bridging the Gap Between Research and Practice

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