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].

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

Related Posts:

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