Predictors of Revision Surgery After Primary Anterior Cruciate Ligament Reconstruction

Yabroudi, Mohammad A.; Björnsson, Haukur; Lynch, Andrew D.; Muller, Bart; Samuelsson, Kristian; Tarabichi, Majd; Karlsson, Jón; Fu, Freddie H.; Harner, Christopher D.; Irrgang, James J.

doi:10.1177/2325967116666039

Cited by 73 publications

(65 citation statements)

References 40 publications

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“…In a case-control study of 251 participants aged 26.1 AE 9.9 years, it was identified that allografts (OR: 2.37, 95% CI: 0.91-6.18) and patients younger than 18 years (OR: 9.52, 95% CI: 2.05-44.26) were a few of many predictors of revision surgery. 26 In this systematic review, two studies (n ¼ 99; 24.4%) compared the outcomes of allograft versus autograft ACLR. In a retrospective review of 534 primary ACLR cases aged 14.8 AE 1.1 (range: 11.3-16.9), the reported aseptic revision rates for BPTB autograft, hamstring autograft, and allograft (not specified) were 5.5, 7.5, and 13.2%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Primary Allograft ACL Reconstruction in Skeletally Immature Patients—A Systematic Review of Surgical Techniques, Outcomes, and Complications

Shanmugaraj

Skelly

et al. 2018

J Knee Surg

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The purpose of this systematic review is to ascertain the risk profile of allografts in primary anterior cruciate ligament reconstruction (ACLR) of skeletally immature patients. Three databases (PubMed, EMBASE, and MEDLINE) were searched for articles addressing primary ACLR in skeletally immature patients (i.e., open femoral and tibial physes). Inclusion criteria encompassed the use of allograft tissue with available postoperative outcomes data. The methodological index for non-randomized studies (MINORS) was used to assess all studies. Descriptive statistics such as means, 95% confidence intervals and standard deviations are presented where applicable. A total of 3,852 studies were screened, with 9 studies of a total of 406 skeletally immature patients (mean age 14.9 ± 1.2 years) satisfying inclusion criteria. The majority (98%) of included patients underwent complete transphyseal ACLR. Where specified, allograft options included Achilles tendon (AT) (66.5%), tibialis anterior tendon (7.6%), bone-patellar tendon (2.5%), and fascia lata (1.0%). The use of a bone block for the AT was reported in one patient (0.2%). Postoperatively, and where specified, patients achieved full range of motion (12.1%), had good Lysholm scores of 94 to 100 (8.1%), and a return to preinjury level athletic participation of 82.9% (8.4%). Complications (13.3%) included graft failures (7.9%), nonrevision reoperation (4.7%), and a combined leg length discrepancy and angular (valgus and extension) deformity (0.2%). There were no reported incidences of disease transmission. Although failure rates of primary allograft ACL reconstruction are acceptable compared with other studies of mainly autograft use in this young, high-risk population, there was a very low rate of clinically significant physeal damage. However, the relatively low quality of the included studies limits the ability to recommend routine use of allograft for ACLR in the skeletally immature patient. More robust studies with long-term follow-up data are necessary to better ascertain the influence of allograft choice on postoperative outcomes for these young patients. This is a Level IV study, systematic review of Levels III and IV studies.

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Section: Discussionmentioning

confidence: 99%

Primary Allograft ACL Reconstruction in Skeletally Immature Patients—A Systematic Review of Surgical Techniques, Outcomes, and Complications

Shanmugaraj

Skelly

et al. 2018

J Knee Surg

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“…Even with the most accurate individualized, anatomic approach to ACL reconstruction, the potential for graft failure still exists, with reported retear rates as low as 5%, 2 and even higher in female athletes 3 or patients reconstructed with allograft. 4 One of the biggest challenges is how we translate the results from animal models to larger human models.…”

Section: See Related Article On Page 331mentioning

confidence: 99%

Editorial Commentary: Adult Stem Cell Potential to Enhance Healing of the Anterior Cruciate Ligament

Chambers

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Even with the most accurate individualized, anatomic approach to anterior cruciate ligament (ACL) reconstruction, the potential for graft failure still exists, with reported retear rates as low as 5%, and even higher in female athletes or patients reconstructed with allograft. ACL graft healing is dependent on several factors, including anatomic placement, appropriate graft choice, proper technique, recovery time, and the biological environment of nature. If the double-bundle concept is followed and individualized for each patient's anatomic morphology, the ACL will biologically reform. The use of adult stem cells may help to contribute to the biological environment and aid in a faster healing time and quicker return to the preoperative state. There is a need for long-term studies and further research in human models to determine the optimal indication and environment for tissue healing with stem cell treatment.

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“…Several methods of ACL reconstruction using autografts or allografts of the hamstrings or patellar tendon have been under investigation in the last decades for the management of ACL tears [1, 7]. However, the long-term outcomes of current reconstruction methods remain unsatisfactory with high failure rates, thus revisions are necessary [8]. …”

Section: Introductionmentioning

confidence: 99%

Mechanical Loading Improves Tendon-Bone Healing in a Rabbit Anterior Cruciate Ligament Reconstruction Model by Promoting Proliferation and Matrix Formation of Mesenchymal Stem Cells and Tendon Cells

Song

Jiang

Wang

et al. 2017

Cell Physiol Biochem

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Background/Aims: This study investigated the effect of mechanical stress on tendon-bone healing in a rabbit anterior cruciate ligament (ACL) reconstruction model as well as cell proliferation and matrix formation in co-culture of bone-marrow mesenchymal stem cells (BMSCs) and tendon cells (TCs). Methods: The effect of continuous passive motion (CPM) therapy on tendon-bone healing in a rabbit ACL reconstruction model was evaluated by histological analysis, biomechanical testing and gene expressions at the tendon-bone interface. Furthermore, the effect of mechanical stretch on cell proliferation and matrix synthesis in BMSC/TC co-culture was also examined. Results: Postoperative CPM therapy significantly enhanced tendon-bone healing, as evidenced by increased amount of fibrocartilage, elevated ultimate load to failure levels, and up-regulated gene expressions of Collagen I, alkaline phosphatase, osteopontin, Tenascin C and tenomodulin at the tendon-bone junction. In addition, BMSC/TC co-culture treated with mechanical stretch showed a higher rate of cell proliferation and enhanced expressions of Collagen I, Collagen III, alkaline phosphatase, osteopontin, Tenascin C and tenomodulin than that of controls. Conclusion: These results demonstrated that proliferation and differentiation of local precursor cells could be enhanced by mechanical stimulation, which results in enhanced regenerative potential of BMSCs and TCs in tendon-bone healing.

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Predictors of Revision Surgery After Primary Anterior Cruciate Ligament Reconstruction

Cited by 73 publications

References 40 publications

Primary Allograft ACL Reconstruction in Skeletally Immature Patients—A Systematic Review of Surgical Techniques, Outcomes, and Complications

Primary Allograft ACL Reconstruction in Skeletally Immature Patients—A Systematic Review of Surgical Techniques, Outcomes, and Complications

Editorial Commentary: Adult Stem Cell Potential to Enhance Healing of the Anterior Cruciate Ligament

Mechanical Loading Improves Tendon-Bone Healing in a Rabbit Anterior Cruciate Ligament Reconstruction Model by Promoting Proliferation and Matrix Formation of Mesenchymal Stem Cells and Tendon Cells

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