Revision ACL reconstruction with autograft: long-term functional outcomes and influencing factors

Boyle, Connor; Pagoti, R.; Eng, Khemerin; McMahon, Samuel E.; Nicholas, Richard W.

doi:10.1007/s00590-018-2277-9

Cited by 7 publications

(9 citation statements)

References 22 publications

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“…10 This longitudinal cohort study design allows us to analyze how various baseline factors affect outcomes over time. There are few comparative data from the literature, as only 5 previous studies with 159 patients have a minimum 5-year follow-up to revision ACL reconstruction, 4,7,8,11,12 so the most relevant comparison is with our .023 a Data are presented as odd ratio (9.% CI); P value (where significant). An empty cell indicates that the knee rating at the top of the column was not significantly affected by meniscal and articular surface conditions.…”

Section: Discussionmentioning

confidence: 99%

“…This longitudinal cohort study design allows us to analyze how various baseline factors affect outcomes over time. There are few comparative data from the literature, as only 5 previous studies with 159 patients have a minimum 5-year follow-up to revision ACL reconstruction, 4,7,8,11,12 so the most relevant comparison is with our previously published 2-year results. 10 Meniscal and/or chondral damage did not predict Marx activity level at 2-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are consistent with previous literature reporting that meniscal pathology negatively affects outcome scores in the revision ACL reconstruction setting. 2,4,15,17,18 Anand et al 2 reported on 136 patients with a mean 5-year follow-up. Patients with an intact medial meniscus had significantly higher KOOS QOL scores at follow-up as compared with patients with medial meniscal pathology.…”

Section: Discussionmentioning

confidence: 99%

“…Chondral pathology has been found to negatively affect patient outcomes in the midterm follow-up revision setting. 2,4,17 Anand et al 2 reported significantly lower 5-year Marx activity, KOOS QOL, and IKDC scores for patients with initial grade 3 or 4 chondral damage at the time of revision surgery as compared with those with grade 0, 1, or 2 changes. Similarly, Webster et al 17 noted significantly reduced functional scores (IKDC, KOOS QOL, Marx, and SANE) and lower rates of return to sports after 5 years in patients with revision ACL who had grade 3 or 4 chondral damage noted at the time of their revision surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Boyle et al 4 followed 43 patients with revision ACL over a mean follow-up of 9 years (range, 5-15 years) and found a statistically significant correlation between increasing age and worse functional outcome scores (Lysholm) in those who had grade 3 or 4 chondral damage. Specifically, patients who had grade 3 or 4 chondral damage showed a reduction of about 25 points in the Lysholm score for every 10-year increase in age.…”

Section: Discussionmentioning

confidence: 99%

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Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study

et al. 2023

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Background: Meniscal and chondral damage is common in the patient undergoing revision anterior cruciate ligament (ACL) reconstruction. Purpose: To determine if meniscal and/or articular cartilage pathology at the time of revision ACL surgery significantly influences a patient’s outcome at 6-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing revision ACL reconstruction were prospectively enrolled between 2006 and 2011. Data collection included baseline demographics, surgical technique, pathology, treatment, and scores from 4 validated patient-reported outcome instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx Activity Rating Scale. Patients were followed up at 6 years and asked to complete the identical set of outcome instruments. Regression analysis assessed the meniscal and articular cartilage pathology risk factors for clinical outcomes 6 years after revision ACL reconstruction. Results: An overall 1234 patients were enrolled (716 males, 58%; median age, 26 years). Surgeons reported the pathology at the time of revision surgery in the medial meniscus (45%), lateral meniscus (36%), medial femoral condyle (43%), lateral femoral condyle (29%), medial tibial plateau (11%), lateral tibial plateau (17%), patella (30%), and trochlea (21%). Six-year follow-up was obtained on 79% of the sample (980/1234). Meniscal pathology and articular cartilage pathology (medial femoral condyle, lateral femoral condyle, lateral tibial plateau, trochlea, and patella) were significant drivers of poorer patient-reported outcomes at 6 years (IKDC, KOOS, WOMAC, and Marx). The most consistent factors driving outcomes were having a medial meniscal excision (either before or at the time of revision surgery) and patellofemoral articular cartilage pathology. Six-year Marx activity levels were negatively affected by having either a repair/excision of the medial meniscus (odds ratio range, 1.45-1.72; P≤ .04) or grade 3-4 patellar chondrosis (odds ratio, 1.72; P = .04). Meniscal pathology occurring before the index revision surgery negatively affected scores on all KOOS subscales except for sports/recreation ( P < .05). Articular cartilage pathology significantly impaired all KOOS subscale scores ( P < .05). Lower baseline outcome scores, higher body mass index, being a smoker, and incurring subsequent surgery all significantly increased the odds of reporting poorer clinical outcomes at 6 years. Conclusion: Meniscal and chondral pathology at the time of revision ACL reconstruction has continued significant detrimental effects on patient-reported outcomes at 6 years after revision surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study

et al. 2023

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Goal setting practices used within anterior cruciate ligament rehabilitation: An exploration of physiotherapists understanding, training and experiences

Alexanders

Perry²,

Douglas

2021

Musculoskeletal Care

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Background: Anterior cruciate ligament (ACL) injuries are a common injury that occurs in both the sporting and non-sporting population. Goal setting is said to be an effective psychological tool within ACL rehabilitation and is commonly used by physiotherapists. To date, literature surrounding goal setting practices is under analysed in relation to qualitative research. Purpose:The central aim of this study was to explore UK physiotherapists understanding, experiences and training towards goal setting practices used in ACL rehabilitation and whether they are effective.Method: Semi-structured interviews involving 24 participants across three specific areas including: National Health Service, elite sport and academia were conducted using an inductive approach. Data analysis included thematic analysis with triangulation and a comprehensive multi-staged analysis process to enhance trustworthiness, whilst respecting ethical considerations.Results/Discussion: Participants from all three areas of practice tended to use the same approach which was SMART goals. All participants lacked any theoretical understanding of goals but would welcome further training in the field. Participants were missing important aspects of setting goals such as not addressing expectations and underutilising feedback. Conclusion:These findings suggest that a call for more psychological training is clearly warranted in both the physiotherapy curriculum and within post graduate CPD training. Creating a specialist interest group (e.g. physiotherapists interested in psychology) may help share good psychological practices and overall enhance understanding in this field.

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Trauma and femoral tunnel position are the most common failure modes of anterior cruciate ligament reconstruction: a systematic review

Vermeijden

Yang

List

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To improve outcomes of anterior cruciate ligament reconstruction (ACLR), it is important to understand the reasons for failure of this procedure. This systematic review was performed to identify current failure modes of ACLR. Methods A systematic search was performed using PubMed, EMBASE, Cochrane, and annual registries for ACLR failures. Studies were included when failure modes were reported (I) of ≥ 10 patients and (II) at a minimum of two-year followup. Modes of failure were also compared between different graft types and in femoral tunnel positions. Results This review included 24 cohort studies and 4 registry-based studies (1 level I, 1 level II, 10 level III, and 16 level IV studies). Overall, a total of 3657 failures were identified. The most common single failure mode of ACLR was new trauma (38%), followed by technical errors (22%), combined causes (i.e. multiple failure mechanisms; 19%), and biological failures (i.e. failure due to infection or laxity without traumatic or technical considerations; 8%). Technical causes also played a contributing role in 17% of all failures. Femoral tunnel malposition was the most common cause of technical failure (63%). When specifically looking at the bone-patellar tendon-bone (BPTB) or hamstring (HT) autografts, trauma was the most common failure mode in both, whereas biological failure was more pronounced in the HT group (4% vs. 22%, respectively). Technical errors were more common following transtibial as compared to anteromedial portal techniques (49% vs. 26%). Conclusion Trauma is the single leading cause of ACLR failure, followed by technical errors, and combined causes. Technical errors seemed to play a major or contributing role in large part of reported failures, with femoral tunnel malposition being the leading cause of failure. Trauma was also the most common failure mode in both BPTB and HT grafts. Technical errors were a more common failure mode following transtibial than anteromedial portal technique. Level of evidence IV.

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Revision ACL reconstruction with autograft: long-term functional outcomes and influencing factors

Abstract: Revision ACL reconstruction with autograft affords satisfactory long-term outcomes. Expectations should be carefully managed in patients with increasing age associated with severe chondral damage and previous medial meniscectomy.

Cited by 7 publications

References 22 publications

Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study

Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study

Goal setting practices used within anterior cruciate ligament rehabilitation: An exploration of physiotherapists understanding, training and experiences

Trauma and femoral tunnel position are the most common failure modes of anterior cruciate ligament reconstruction: a systematic review

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