Rerupture, reinjuries, and revisions at a minimum 2-year follow-up: A randomized clinical trial comparing 2 graft types for ACL reconstruction.
Mohtadi N, Chan D, Barber R, and Paolucci EO. Clin J Sports Med. 2015. [Epub Ahead of Print].
Take Home Message: Two years after anterior cruciate ligament (ACL) reconstruction, a patient who was treated with patellar tendon grafts was less likely to sustain reinjury than a patient who received a hamstring graft. Further, a younger patient (27 years old or younger) was more likely to have an adverse event than an older patient.
Anterior cruciate ligament ruptures in the athletic population are common and has long-term effects on a patient’s health. Even more disruptive to the long-term health of a joint, are rerupture and reinjuries to the same joint. By identifying factors that may lead to reinjuries, clinicians may be able to implement preventions strategies to reduce the risk of reinjuries. Therefore, Mohtadi and colleagues completed a double-blinded randomized clinical trial to compare 3 autograft options with regards to reinjury at 2 years post-surgery. A total of 330 patients were randomized into 1 of 3 graft groups: patellar tendon, quadruple-stranded hamstring tendon, and double-bundle hamstring tendon. All included patients underwent identical surgical and rehabilitation protocols. Blinded, independent examiners performed clinical and functional evaluations as well as assessed all adverse events for all patients at 2 years post-surgery. All adverse events were classified as complete traumatic reruptures, partial traumatic tears, and atraumatic graft failures (≥ 6 mm different in anterior tibial translation, no traumatic event). The authors defined a reinjury as any patient with a traumatic rerupture or partial traumatic tear. Overall, there was no demographic difference between the 3 groups. Seventeen patients (5.2%) suffered a rerupture. Patients who received patellar tendon grafts (3 reinjuries, 3%) were the least likely to sustain a reinjury (quadruple-stranded: 12 reinjuries, 11%; double-bundle: 11 reinjuries, 10%). There was no difference between groups with regards to atraumatic graft failure. The only significant predictive factor measured was age, with a patient 27 years or younger being more likely to sustain reinjury than an older patient.
Overall, this study presents some interesting data for clinicians to consider. Primarily, that age was a significant factor in reinjury following ACL reconstruction. This is something which may be considered for immediate consideration following ACL reconstruction. Clinicians may want to consider more closely monitoring younger patients who have undergone ACL reconstruction. It may also be prudent to for clinicians to consider additional education for younger patients to encourage a more cautious approach to preserve long-term joint health. It should be noted though that younger patients may be at greater risk for reinjury because they put themselves in situations which increase the risk of reinjury (e.g., more sports, more aggressive play). Until further research can be completed, clinicians should consider the implementation of more injury prevention programs, especially when treating younger patients following ACL reconstruction.
Questions for Discussion: Do you treat ACL reconstruction patients differently based on age? If so, what is the most significant difference in treatments?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
ACL Graft Type May Not Matter When Attempting to Improve Patient-Reported Outcome 2-Years Post-Surgery
Mohtadi, N., Chan, D., Barber, R., & Paolucci, E. (2015). Reruptures, Reinjuries, and Revisions at a Minimum 2-Year Follow-up Clinical Journal of Sport Medicine DOI: 10.1097/JSM.0000000000000209