Open AccessAge, time from injury to surgery and quadriceps strength affect the risk of revision surgery after primary ACL reconstruction
Author(s) -
Cristiani Riccardo,
Forssblad Magnus,
Edman Gunnar,
Eriksson Karl,
Stålman Anders
Publication year - 2021
Publication title -
knee surgery, sports traumatology, arthroscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.806
H-Index - 125
eISSN - 1433-7347
pISSN - 0942-2056
DOI - 10.1007/s00167-021-06517-8
Subject(s) - medicine , surgery , anterior cruciate ligament reconstruction , body mass index , hamstring , univariate analysis , odds ratio , meniscus , acl injury , anterior cruciate ligament , incidence (geometry) , multivariate analysis , physics , optics
Purpose To identify preoperative, intraoperative and postoperative factors associated with revision anterior cruciate ligament reconstruction (ACLR) within 2 years of primary ACLR. Methods Patients who underwent primary ACLR at our institution, from January 2005 to March 2017, were identified. The primary outcome was the occurrence of revision ACLR within 2 years of primary ACLR. Univariate and multivariate logistic regression analyses were used to evaluate preoperative [age, gender, body mass index (BMI), time from injury to surgery, pre‐injury Tegner activity level], intraoperative [graft type, graft diameter, medial meniscus (MM) and lateral meniscus (LM) resection or repair, cartilage injury] and postoperative [side‐to‐side (STS) anterior laxity, limb symmetry index (LSI) for quadriceps and hamstring strength and single‐leg‐hop test performance at 6 months] risk factors for revision ACLR. Results A total of 6,510 primary ACLRs were included. The overall incidence of revision ACLR within 2 years was 2.5%. Univariate analysis showed that age < 25 years, BMI < 25 kg/m 2 , time from injury to surgery < 12 months, pre‐injury Tegner activity level ≥ 6, LM repair, STS laxity > 5 mm, quadriceps strength and single‐leg‐hop test LSI of ≥ 90% increased the odds; whereas, MM resection and the presence of a cartilage injury reduced the odds of revision ACLR. Multivariate analysis revealed that revision ACLR was significantly related only to age < 25 years (OR 6.25; 95% CI 3.57–11.11; P < 0.001), time from injury to surgery < 12 months (OR 2.27; 95% CI 1.25–4.17; P = 0.007) and quadriceps strength LSI of ≥ 90% (OR 1.70; 95% CI 1.16–2.49; P = 0.006). Conclusion Age < 25 years, time from injury to surgery < 12 months and 6‐month quadriceps strength LSI of ≥ 90% increased the odds of revision ACLR within 2 years of primary ACLR. Understanding the risk factors for revision ACLR has important implications when it comes to the appropriate counseling for primary ACLR. In this study, a large spectrum of potential risk factors for revision ACLR was analyzed in a large cohort. Advising patients regarding the results of an ACLR should also include potential risk factors for revision surgery. Level of evidence III.