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Acute and subacute anterior cruciate ligament reconstructions are associated with a higher risk of revision and reoperation

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

(1) Report concomitant cartilage and meniscal injury at the time of anterior cruciate ligament reconstruction (ACLR), (2) evaluate the risk of aseptic revision ACLR during follow-up, and (3) evaluate the risk of aseptic ipsilateral reoperation during follow-up.

Methods

Using a United States integrated healthcare system’s ACLR registry, patients who underwent primary isolated ACLR were identified (2010–2018). Multivariable Cox proportional-hazards regression was used to evaluate the risk of aseptic revision, with a secondary outcome evaluating ipsilateral aseptic reoperation. Outcomes were evaluated by time from injury to ACLR: acute (< 3 weeks), subacute (3 weeks–3 months), delayed (3–9 months), and chronic (≥ 9 months).

Results

The final sample included 270 acute (< 3 weeks), 5971 subacute (3 weeks–3 months), 5959 delayed (3–9 months), and 3595 chronic (≥ 9 months) ACLR. Medial meniscus [55.4% (1990/3595 chronic) vs 38.9% (105/270 acute)] and chondral injuries [40.0% (1437/3595 chronic) vs 24.8% (67/270 acute)] at the time of ACLR were more common in the chronic versus acute groups. The crude 6-year revision rate was 12.9% for acute ACLR, 7.0% for subacute, 5.1% for delayed, and 4.4% for chronic ACLR; reoperation rates a 6-year follow-up was 15.0% for acute ACLR, 9.6% for subacute, 6.4% for delayed, and 8.1% for chronic ACLR. After adjustment for covariates, acute and subacute ACLR had higher risks for aseptic revision (acute HR 1.70, 95% CI 1.07–2.72, p = 0.026; subacute HR 1.25, 95% CI 1.01–1.55, p = 0.040) and aseptic reoperation (acute HR 2.04, 95% CI 1.43–2.91, p < 0.001; subacute HR 1.31, 95% CI 1.11–1.54, p = 0.002) when compared to chronic ACLR.

Conclusions

In this cohort study, while more meniscal and chondral injuries were reported for ACLR performed ≥ 9 months after the date of injury, a lower risk of revision and reoperation was observed following chronic ACLR relative to patients undergoing surgery in acute or subacute fashions.

Level of evidence

III.

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Abbreviations

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

ACLRR:

Anterior cruciate ligament reconstruction registry

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

BPTB:

Bone patellar tendon bone

CI:

Confidence interval

CIF:

Cumulative incidence function

EHR:

Electronic health record

HR:

Hazard ratio

IQR:

Interquartile range

ROM:

Range of motion

SD:

Standard deviation

US:

United States

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Acknowledgements

The authors acknowledge the Kaiser Permanente orthopaedic surgeons who contribute to the Kaiser Permanente ACLRR as well as the Surgical Outcomes and Analysis Department staff, which coordinates registry operations.

Funding

No outside funding was obtained.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Permanente Medical Group, 2nd Floor, 1600 Owens St, San Francisco, CA, 94158, USA

    David Y. Ding

  2. Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA

    Richard N. Chang & Heather A. Prentice

  3. University of California San Francisco, UCSF Medical Center, San Francisco, CA, USA

    Sachin Allahabadi & Monica J. Coughlan

  4. Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Baldwin Park, CA, USA

    Gregory B. Maletis

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  1. David Y. Ding
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  5. Heather A. Prentice
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Contributions

DYD, SA, MJC, HAP, and GBM contributed to overall conception and design of the study. RNC and HAP took part in data acquisition. RNC completed the statistical analysis. DYD, RNC, SA, and MJC drafted the manuscript. DYD, RNC, SA, MJC, HAP, and GBM reviewed the manuscript, contributed to revisions, gave approval of the final draft, and agree to be accountable for all aspects of the work.

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Correspondence to David Y. Ding.

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The authors report no conflicts.

Ethical approval

This study was approved by Kaiser Permanente’s Institutional Review Board (#5691) prior to commencement.

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Ding, D.Y., Chang, R.N., Allahabadi, S. et al. Acute and subacute anterior cruciate ligament reconstructions are associated with a higher risk of revision and reoperation. Knee Surg Sports Traumatol Arthrosc 30, 3311–3321 (2022). https://doi.org/10.1007/s00167-022-06912-9

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