Survival of the
Anterior Cruciate Ligament Graft and the Contralateral ACL at a Minimum of 15
Years

Bourke HE, Salmon LJ, Waller A, Patterson V, Pinczewski
LA. Am J Sports Med. 2012 Aug 6. [Epub ahead of print]

Anterior cruciate ligament injury is devastating to the
athletic career of an athlete, but it is also potentially only the beginning of
knee problems for an athlete.  ACL
reconstruction likely follows, which can restore static stability (but not
prevent the development of arthritis or guarantee a return to sports), but we
know that there is at least some risk for suffering a graft injury or a contralateral
ACL injury. However, like many aspects of function after ACL injury, we don’t
have sample sizes large enough with adequate follow-up to determine the true
prevalence or risk factors for these re-injuries.  The purpose of this investigation was to do
just that.  To achieve this objective
patients undergoing ACLR at a minimum of 15 years prior were contacted to
complete the IKDC2000 Subjective Knee Form and a telephone interview to determine
their self-reported function, activity level, and any injury to either the ACL
graft or the contralateral ACL (CACL). Of 755 eligible subjects, 673 completed
the follow-up, 23% of whom had sustained an injury to either ACL.  Risk factors for an ACL graft rupture
included being a male and having a positive family history of ACL rupture.  Risk factors for a contralateral ACL rupture
included being 18 or younger at the time of surgery, returning to sport and
having a positive family history of ACL rupture.  The period of greatest risk for a graft
rupture was in the first two years after reconstruction and between one and
four years post reconstruction for the CACL.

Patients are clearly at risk for injury to the graft or
contralateral ACL in the post-operative period, as indicated here and in a 5
year follow-up from Shelbourne
et
al.  The
risk-factors identified consistently include young athletes (18 or younger at
the time of reconstruction) which return to high level activities.  However, as pointed out in the discussion of
this paper, it may simply be due to greater exposure to injurious
situations.  Regardless, as a medical
professional, this is something we must consider when preparing our young
athletes for returning to sports. 
Interestingly, the only risk factors discussed in this report are
largely non-modifiable from a rehabilitation standpoint (one could argue that
returning to sport is modifiable, however, to many patients this is not an
option). Further research is needed to identify if the high risk period between
one and two years after ACLR is due to inadequate rehabilitation and poor
movement patterns, structural predisposition to injury, or some combination of
both. We know that time from injury doesnt adequately identify functional deficits after ACLR. But as previously mentioned, objective return to sport criteria are lacking in predicting failure
What do you tell your patients about their likelihood of re-injury when
returning to sport after ACLR? Do you implement a systematic injury prevention
program for your younger patients?  Are
there any criteria that you find to be predictive of future injury that are
potentially modifiable?

Written by: 
Andrew Lynch
Reviewed by: 
Stephen Thomas

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Bourke HE, Salmon LJ, Waller A, Patterson V, & Pinczewski LA (2012). Survival of the Anterior Cruciate Ligament Graft and the Contralateral ACL at a Minimum of 15 Years. The American Journal of Sports Medicine, 40 (9), 1985-92 PMID: 22869626