학술논문

Differences in Mechanisms of Failure, Intraoperative Findings, and Surgical Characteristics Between Single- and Multiple-Revision ACL Reconstructions
Document Type
article
Author
Chen, James LAllen, Christina RStephens, Thomas EHaas, Amanda KHuston, Laura JWright, Rick WFeeley, Brian TAlbright, John PAmendola, Annunziato NedAnderson, Allen FAndrish, Jack TAnnunziata, Christopher CArciero, Robert ABach, Bernard RBaker, Champ LBartolozzi, Arthur RBaumgarten, Keith MBechler, Jeffery RBerg, Jeffrey HBernas, GeoffBrockmeier, Stephen FBrophy, Robert HBush-Joseph, Charles AButler, J BradCampbell, John DCarey, James LCarpenter, James ECole, Brian JCooper, Daniel ECooper, Jonathan MCox, Charles LCreighton, R AlexanderDahm, Diane LDavid, Tal SDeBerardino, Thomas MDunn, Warren RFlanigan, David CFrederick, Robert WGanley, Theodore JGatt, Charles JGecha, Steven RGiffin, James RobertHame, Sharon LHannafin, Jo AHarner, Christopher DHarris, Norman LindsayHechtman, Keith SHershman, Elliott BHoellrich, Rudolf GHosea, Timothy MJohnson, David CJohnson, Timothy SJones, Morgan HKaeding, Christopher CKamath, Ganesh VKlootwyk, Thomas ELantz, Brett Brick ALevy, Bruce AMa, C BenjaminMaiers, G PeterMann, BartonMarx, Robert GMatava, Matthew JMathien, Gregory MMcAllister, David RMcCarty, Eric CMcCormack, Robert GMiller, Bruce SNissen, Carl WO’Neill, Daniel FOwens, MAJ Brett DParker, Richard DPurnell, Mark LRamappa, Arun JRauh, Michael ARettig, Arthur CSekiya, Jon KShea, Kevin GSherman, Orrin HSlauterbeck, James RSmith, Matthew VSpang, Jeffrey TSpindler, Kurt PStuart, Michael JSvoboda, LTC Steven JTaft, Timothy NTenuta, COL Joachim JTingstad, Edwin MVidal, Armando FViskontas, Darius GWhite, Richard AWilliams, James SWolcott, Michelle LWolf, Brian RYork, James J
Source
The American Journal of Sports Medicine. 41(7)
Subject
Physical Injury - Accidents and Adverse Effects
Transplantation
Arthritis
Clinical Research
Injuries and accidents
Adolescent
Adult
Anterior Cruciate Ligament Reconstruction
Case-Control Studies
Child
Female
Humans
Knee Injuries
Male
Middle Aged
Prospective Studies
Reoperation
Transplantation
Autologous
Transplantation
Homologous
Treatment Failure
United States
Young Adult
ACL
ACL revision
allograft
autograft
Multicenter ACL Revision Study (MARS) Group
Biomedical Engineering
Mechanical Engineering
Human Movement and Sports Sciences
Orthopedics
Language
Abstract
BackgroundThe factors that lead to patients failing multiple anterior cruciate ligament (ACL) reconstructions are not well understood.HypothesisMultiple-revision ACL reconstruction will have different characteristics than first-time revision in terms of previous and current graft selection, mode of failure, chondral/meniscal injuries, and surgical charactieristics.Study designCase-control study; Level of evidence, 3.MethodsA prospective multicenter ACL revision database was utilized for the time period from March 2006 to June 2011. Patients were divided into those who underwent a single-revision ACL reconstruction and those who underwent multiple-revision ACL reconstructions. The primary outcome variable was Marx activity level. Primary data analyses between the groups included a comparison of graft type, perceived mechanism of failure, associated injury (meniscus, ligament, and cartilage), reconstruction type, and tunnel position. Data were compared by analysis of variance with a post hoc Tukey test.ResultsA total of 1200 patients (58% men; median age, 26 years) were enrolled, with 1049 (87%) patients having a primary revision and 151 (13%) patients having a second or subsequent revision. Marx activity levels were significantly higher (9.77) in the primary-revision group than in those patients with multiple revisions (6.74). The most common cause of reruptures was a traumatic, noncontact ACL graft injury in 55% of primary-revision patients; 25% of patients had a nontraumatic, gradual-onset recurrent injury, and 11% had a traumatic, contact injury. In the multiple-revision group, a nontraumatic, gradual-onset injury was the most common cause of recurrence (47%), followed by traumatic noncontact (35%) and nontraumatic sudden onset (11%) (P < .01 between groups). Chondral injuries in the medial compartment were significantly more common in the multiple-revision group than in the single-revision group, as were chondral injuries in the patellofemoral compartment.ConclusionPatients with multiple-revision ACL reconstructions had lower activity levels, were more likely to have chondral injuries in the medial and patellofemoral compartments, and had a high rate of a nontraumatic, recurrent injury of their graft.