1
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Wright RW, Huston LJ, Haas AK, Pennings JS, Allen CR, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Spindler KP, Stuart MJ, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study. Am J Sports Med 2023; 51:605-614. [PMID: 36734487 PMCID: PMC10338044 DOI: 10.1177/03635465231151389] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Meniscal and chondral damage is common in the patient undergoing revision anterior cruciate ligament (ACL) reconstruction. PURPOSE To determine if meniscal and/or articular cartilage pathology at the time of revision ACL surgery significantly influences a patient's outcome at 6-year follow-up. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients undergoing revision ACL reconstruction were prospectively enrolled between 2006 and 2011. Data collection included baseline demographics, surgical technique, pathology, treatment, and scores from 4 validated patient-reported outcome instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx Activity Rating Scale. Patients were followed up at 6 years and asked to complete the identical set of outcome instruments. Regression analysis assessed the meniscal and articular cartilage pathology risk factors for clinical outcomes 6 years after revision ACL reconstruction. RESULTS An overall 1234 patients were enrolled (716 males, 58%; median age, 26 years). Surgeons reported the pathology at the time of revision surgery in the medial meniscus (45%), lateral meniscus (36%), medial femoral condyle (43%), lateral femoral condyle (29%), medial tibial plateau (11%), lateral tibial plateau (17%), patella (30%), and trochlea (21%). Six-year follow-up was obtained on 79% of the sample (980/1234). Meniscal pathology and articular cartilage pathology (medial femoral condyle, lateral femoral condyle, lateral tibial plateau, trochlea, and patella) were significant drivers of poorer patient-reported outcomes at 6 years (IKDC, KOOS, WOMAC, and Marx). The most consistent factors driving outcomes were having a medial meniscal excision (either before or at the time of revision surgery) and patellofemoral articular cartilage pathology. Six-year Marx activity levels were negatively affected by having either a repair/excision of the medial meniscus (odds ratio range, 1.45-1.72; P≤ .04) or grade 3-4 patellar chondrosis (odds ratio, 1.72; P = .04). Meniscal pathology occurring before the index revision surgery negatively affected scores on all KOOS subscales except for sports/recreation (P < .05). Articular cartilage pathology significantly impaired all KOOS subscale scores (P < .05). Lower baseline outcome scores, higher body mass index, being a smoker, and incurring subsequent surgery all significantly increased the odds of reporting poorer clinical outcomes at 6 years. CONCLUSION Meniscal and chondral pathology at the time of revision ACL reconstruction has continued significant detrimental effects on patient-reported outcomes at 6 years after revision surgery.
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Affiliation(s)
| | | | - Amanda K Haas
- Washington University in St Louis, St Louis, Missouri, USA
| | | | | | | | | | | | | | | | | | - John P Albright
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | | | | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | | | | | - Arthur R Bartolozzi
- 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | | | | | - Jeffrey H Berg
- Town Center Orthopaedic Associates, Reston, Virginia, USA
| | | | | | | | | | - J Brad Butler
- Orthopedic and Fracture Clinic, Portland, Oregon, USA
| | - John D Campbell
- Bridger Orthopedic and Sports Medicine, Bozeman, Montana, USA
| | - James L Carey
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, USA
| | | | | | | | | | - Tal S David
- Synergy Specialists Medical Group, San Diego, California, USA
| | | | - Robert W Frederick
- The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Charles J Gatt
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
| | - Steven R Gecha
- Princeton Orthopaedic Associates, Princeton, New Jersey, USA
| | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
| | - Sharon L Hame
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jo A Hannafin
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Ganesh V Kamath
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | | | - C Benjamin Ma
- University of California, San Francisco, California, USA
| | - G Peter Maiers
- Methodist Sports Medicine Center, Indianapolis, Indiana, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | - Eric C McCarty
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
| | - Robert G McCormack
- University of British Columbia/Fraser Health Authority, British Columbia, Canada
| | | | - Carl W Nissen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | | | - Brett D Owens
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | | | | | - Arun J Ramappa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael A Rauh
- State University of New York at Buffalo, Buffalo, New York, USA
| | | | - Jon K Sekiya
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | | - Jeffrey T Spang
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Ltc Steven J Svoboda
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
| | - Timothy N Taft
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | - Edwin M Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA
| | - Armando F Vidal
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
| | | | | | | | | | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - James J York
- Orthopaedic and Sports Medicine Center, LLC, Pasedena, Maryland, USA
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA
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DeFroda SF, Owens BD, Wright RW, Huston LJ, Pennings JS, Haas AK, Allen CR, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Spindler KP, Stuart MJ, Albright JP, Amendola AN, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Descriptive Characteristics and Outcomes of Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction With and Without Tunnel Bone Grafting. Am J Sports Med 2022; 50:2397-2409. [PMID: 35833922 DOI: 10.1177/03635465221104470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lytic or malpositioned tunnels may require bone grafting during revision anterior cruciate ligament reconstruction (rACLR) surgery. Patient characteristics and effects of grafting on outcomes after rACLR are not well described. PURPOSE To describe preoperative characteristics, intraoperative findings, and 2-year outcomes for patients with rACLR undergoing bone grafting procedures compared with patients with rACLR without grafting. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 1234 patients who underwent rACLR were prospectively enrolled between 2006 and 2011. Baseline revision and 2-year characteristics, surgical technique, pathology, treatment, and patient-reported outcome instruments (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale [Marx]) were collected, as well as subsequent surgery information, if applicable. The chi-square and analysis of variance tests were used to compare group characteristics. RESULTS A total of 159 patients (13%) underwent tunnel grafting-64 (5%) patients underwent 1-stage and 95 (8%) underwent 2-stage grafting. Grafting was isolated to the femur in 31 (2.5%) patients, the tibia in 40 (3%) patients, and combined in 88 patients (7%). Baseline KOOS Quality of Life (QoL) and Marx activity scores were significantly lower in the 2-stage group compared with the no bone grafting group (P≤ .001). Patients who required 2-stage grafting had more previous ACLRs (P < .001) and were less likely to have received a bone-patellar tendon-bone or a soft tissue autograft at primary ACLR procedure (P≤ .021) compared with the no bone grafting group. For current rACLR, patients undergoing either 1-stage or 2-stage bone grafting were more likely to receive a bone-patellar tendon-bone allograft (P≤ .008) and less likely to receive a soft tissue autograft (P≤ .003) compared with the no bone grafting group. At 2-year follow-up of 1052 (85%) patients, we found inferior outcomes in the 2-stage bone grafting group (IKDC score = 68; KOOS QoL score = 44; KOOS Sport/Recreation score = 65; and Marx activity score = 3) compared with the no bone grafting group (IKDC score = 77; KOOS QoL score = 63; KOOS Sport/Recreation score = 75; and Marx activity score = 7) (P≤ .01). The 1-stage bone graft group did not significantly differ compared with the no bone grafting group. CONCLUSION Tunnel bone grafting was performed in 13% of our rACLR cohort, with 8% undergoing 2-stage surgery. Patients treated with 2-stage grafting had inferior baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting. Patients treated with 1-stage grafting had similar baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting.
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Affiliation(s)
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- Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Steven F DeFroda
- University of Missouri, Columbia, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Brett D Owens
- Brown Alpert Medical School, Providence, Rhode Island, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Rick W Wright
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Laura J Huston
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jacquelyn S Pennings
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Amanda K Haas
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Christina R Allen
- Yale University, New Haven, Connecticut, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Daniel E Cooper
- W.B. Carrell Memorial Clinic, Dallas, Texas, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Thomas M DeBerardino
- The San Antonio Orthopaedic Group, San Antonio, Texas, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Warren R Dunn
- Texas Orthopedic Hospital, Houston, Texas, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Brett Brick A Lantz
- Slocum Research & Education Foundation, Eugene, Oregon, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Kurt P Spindler
- Cleveland Clinic, Cleveland, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Michael J Stuart
- Mayo Clinic, Rochester, Minnesota, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - John P Albright
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Annunziato Ned Amendola
- Duke University, Durham, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Christopher C Annunziata
- Commonwealth Orthopaedics & Rehabilitation, Arlington, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Bernard R Bach
- Rush University Medical Center, Chicago, Illinois, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Champ L Baker
- The Hughston Clinic, Columbus, Georgia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Arthur R Bartolozzi
- 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jeffery R Bechler
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jeffrey H Berg
- Town Center Orthopaedic Associates, Reston, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Geoffrey A Bernas
- State University of New York at Buffalo, Buffalo, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Stephen F Brockmeier
- University of Virginia, Charlottesville, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert H Brophy
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Charles A Bush-Joseph
- Rush University Medical Center, Chicago, Illinois, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - J Brad Butler
- Orthopedic and Fracture Clinic, Portland, Oregon, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James L Carey
- University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James E Carpenter
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Brian J Cole
- Rush University Medical Center, Chicago, IL USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jonathan M Cooper
- HealthPartners Specialty Center, St Paul, Minnesota, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Charles L Cox
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - R Alexander Creighton
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Tal S David
- Synergy Specialists Medical Group, San Diego, California, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - David C Flanigan
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert W Frederick
- Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Elizabeth A Garofoli
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Charles J Gatt
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Steven R Gecha
- Princeton Orthopaedic Associates, Princeton, New Jersey, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Sharon L Hame
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jo A Hannafin
- Hospital for Special Surgery, New York, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Christopher D Harner
- University of Texas Health Center, Houston, Texas, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Norman Lindsay Harris
- Grand River Health-Rifle, Rifle, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Keith S Hechtman
- UHZ Sports Medicine Institute, Coral Gables, Florida, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Elliott B Hershman
- Lenox Hill Hospital, New York, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Rudolf G Hoellrich
- Slocum Research & Education Foundation, Eugene, Oregon, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - David C Johnson
- National Sports Medicine Institute, Leesburg, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Timothy S Johnson
- National Sports Medicine Institute, Leesburg, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Morgan H Jones
- Cleveland Clinic, Cleveland, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Christopher C Kaeding
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Ganesh V Kamath
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Thomas E Klootwyk
- Methodist Sports Medicine, Indianapolis, Indiana, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Bruce A Levy
- Mayo Clinic Rochester, Rochester, Minnesota, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - C Benjamin Ma
- University of California, San Francisco, California, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - G Peter Maiers
- Methodist Sports Medicine Center, Indianapolis, Indiana, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Matthew J Matava
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Gregory M Mathien
- Knoxville Orthopaedic Clinic, Knoxville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - David R McAllister
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Eric C McCarty
- University of Colorado Denver School of Medicine, Denver, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert G McCormack
- University of British Columbia/Fraser Health Authority, British Columbia, Canada.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Bruce S Miller
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Carl W Nissen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Daniel F O'Neill
- Littleton Regional Healthcare, Littleton, New Hampshire, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Richard D Parker
- Cleveland Clinic, Cleveland, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Mark L Purnell
- Aspen Orthopedic Associates, Aspen, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Arun J Ramappa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Michael A Rauh
- State University of New York at Buffalo, Buffalo, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Arthur C Rettig
- Methodist Sports Medicine, Indianapolis, Indiana, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jon K Sekiya
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Kevin G Shea
- Intermountain Orthopaedics, Boise, Idaho, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Orrin H Sherman
- NYU Hospital for Joint Diseases, New York, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James R Slauterbeck
- University of South Alabama, Mobile, Alabama, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Matthew V Smith
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jeffrey T Spang
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Steven J Svoboda
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Timothy N Taft
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Joachim J Tenuta
- Albany Medical Center, Albany, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Edwin M Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Armando F Vidal
- University of Colorado Denver School of Medicine, Denver, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Darius G Viskontas
- Royal Columbian Hospital, New Westminster, British Columbia, Canada.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Richard A White
- Fitzgibbon's Hospital, Marshall, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James S Williams
- Cleveland Clinic, Euclid, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Michelle L Wolcott
- University of Colorado Denver School of Medicine, Denver, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James J York
- Orthopaedic and Sports Medicine Center, LLC, Pasedena, Maryland, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
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Bigouette JP, Owen EC, Lantz BBA, Hoellrich RG, Wright RW, Huston LJ, Haas AK, Allen CR, Cooper DE, DeBerardino TM, Dunn WR, Spindler KP, Stuart MJ, Albright JP, Amendola A(N, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Robert Giffin J, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LTCSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ, York JJ. Returning to Activity After Anterior Cruciate Ligament Revision Surgery: An Analysis of the Multicenter Anterior Cruciate Ligament Revision Study (MARS) Cohort at 2 Years Postoperative. Am J Sports Med 2022; 50:1788-1797. [PMID: 35648628 PMCID: PMC9756873 DOI: 10.1177/03635465221094621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with anterior cruciate ligament (ACL) revision report lower outcome scores on validated knee questionnaires postoperatively compared to cohorts with primary ACL reconstruction. In a previously active population, it is unclear if patient-reported outcomes (PROs) are associated with a return to activity (RTA) or vary by sports participation level (higher level vs. recreational athletes). HYPOTHESES Individual RTA would be associated with improved outcomes (ie, decreased knee symptoms, pain, function) as measured using validated PROs. Recreational participants would report lower PROs compared with higher level athletes and be less likely to RTA. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS There were 862 patients who underwent a revision ACL reconstruction (rACLR) and self-reported physical activity at any level preoperatively. Those who did not RTA reported no activity 2 years after revision. Baseline data included patient characteristics, surgical history and characteristics, and PROs: International Knee Documentation Committee questionnaire, Marx Activity Rating Scale, Knee injury and Osteoarthritis Outcome Score, and the Western Ontario and McMaster Universities Osteoarthritis Index. A binary indicator was used to identify patients with same/better PROs versus worse outcomes compared with baseline, quantifying the magnitude of change in each direction, respectively. Multivariable regression models were used to evaluate risk factors for not returning to activity, the association of 2-year PROs after rACLR surgery by RTA status, and whether each PRO and RTA status differed by participation level. RESULTS At 2 years postoperatively, approximately 15% did not RTA, with current smokers (adjusted odds ratio [aOR] = 3.3; P = .001), female patients (aOR = 2.9; P < .001), recreational participants (aOR = 2.0; P = .016), and those with a previous medial meniscal excision (aOR = 1.9; P = .013) having higher odds of not returning. In multivariate models, not returning to activity was significantly associated with having worse PROs at 2 years; however, no clinically meaningful differences in PROs at 2 years were seen between participation levels. CONCLUSION Recreational-level participants were twice as likely to not RTA compared with those participating at higher levels. Within a previously active cohort, no RTA was a significant predictor of lower PROs after rACLR. However, among patients who did RTA after rACLR, approximately 20% reported lower outcome scores. Most patients with rACLR who were active at baseline improved over time; however, patients who reported worse outcomes at 2 years had a clinically meaningful decline across all PROs.
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Affiliation(s)
| | - Erin C. Owen
- Slocum Research & Education Foundation, Eugene, OR USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tal S. David
- Synergy Specialists Medical Group, San Diego, CA USA
| | | | | | | | | | | | | | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London Ontario, Canada
| | - Sharon L. Hame
- David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | | | | | | | | | | | | | | | | | | | - Ganesh V. Kamath
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | | | | | | | | | | | | | | | - Eric C. McCarty
- University of Colorado Denver School of Medicine, Denver, CO USA
| | - Robert G. McCormack
- University of British Columbia/Fraser Health Authority, British Columbia, Canada
| | | | | | | | - Brett D. Owens
- Warren Alpert Medical School, Brown University, Providence, RI USA
| | | | | | | | | | | | | | | | | | | | | | - Jeffrey T. Spang
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | - Timothy N. Taft
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | - Edwin M. Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, WA USA
| | - Armando F. Vidal
- University of Colorado Denver School of Medicine, Denver, CO USA
| | | | | | | | | | - Brian R. Wolf
- University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | - James J. York
- Orthopaedic and Sports Medicine Center, LLC, Pasedena, MD
| | - James J York
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
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4
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Wright RW, Huston LJ, Haas AK, Pennings JS, Allen CR, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Spindler KP, Stuart MJ, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Brad Butler V J, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Association Between Graft Choice and 6-Year Outcomes of Revision Anterior Cruciate Ligament Reconstruction in the MARS Cohort. Am J Sports Med 2021; 49:2589-2598. [PMID: 34260326 PMCID: PMC9236596 DOI: 10.1177/03635465211027170] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although graft choice may be limited in the revision setting based on previously used grafts, most surgeons believe that graft choice for anterior cruciate ligament (ACL) reconstruction is an important factor related to outcome. HYPOTHESIS In the ACL revision setting, there would be no difference between autograft and allograft in rerupture rate and patient-reported outcomes (PROs) at 6-year follow-up. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients who had revision surgery were identified and prospectively enrolled in this cohort study by 83 surgeons over 52 sites. Data collected included baseline characteristics, surgical technique and pathology, and a series of validated PRO measures. Patients were followed up at 6 years and asked to complete the identical set of PRO instruments. Incidence of additional surgery and reoperation because of graft failure were also recorded. Multivariable regression models were used to determine the predictors (risk factors) of PROs, graft rerupture, and reoperation at 6 years after revision surgery. RESULTS A total of 1234 patients including 716 (58%) men were enrolled. A total of 325 (26%) underwent revision using a bone-patellar tendon-bone (BTB) autograft; 251 (20%), soft tissue autograft; 289 (23%), BTB allograft; 302 (25%), soft tissue allograft; and 67 (5%), other graft. Questionnaires and telephone follow-up for subsequent surgery information were obtained for 809 (66%) patients, while telephone follow-up was only obtained for an additional 128 patients for the total follow-up on 949 (77%) patients. Graft choice was a significant predictor of 6-year Marx Activity Rating Scale scores (P = .024). Specifically, patients who received a BTB autograft for revision reconstruction had higher activity levels than did patients who received a BTB allograft (odds ratio [OR], 1.92; 95% CI, 1.25-2.94). Graft rerupture was reported in 5.8% (55/949) of patients by their 6-year follow-up: 3.5% (16/455) of patients with autografts and 8.4% (37/441) of patients with allografts. Use of a BTB autograft for revision resulted in patients being 4.2 times less likely to sustain a subsequent graft rupture than if a BTB allograft were utilized (P = .011; 95% CI, 1.56-11.27). No significant differences were found in graft rerupture rates between BTB autograft and soft tissue autografts (P = .87) or between BTB autografts and soft tissue allografts (P = .36). Use of an autograft was found to be a significant predictor of having fewer reoperations within 6 years compared with using an allograft (P = .010; OR, 0.56; 95% CI, 0.36-0.87). CONCLUSION BTB and soft tissue autografts had a decreased risk in graft rerupture compared with BTB allografts. BTB autografts were associated with higher activity level than were BTB allografts at 6 years after revision reconstruction. Surgeons and patients should consider this information when choosing a graft for revision ACL reconstruction.
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Affiliation(s)
- Rick W Wright
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura J Huston
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amanda K Haas
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacquelyn S Pennings
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christina R Allen
- Yale University, New Haven, Connecticut, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel E Cooper
- W.B. Carrell Memorial Clinic, Dallas, Texas, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas M DeBerardino
- The San Antonio Orthopaedic Group, San Antonio, Texas, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Warren R Dunn
- Texas Orthopedic Hospital, Houston, Texas, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brett Brick A Lantz
- Slocum Research and Education Foundation, Eugene, Oregon, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kurt P Spindler
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Stuart
- Mayo Clinic, Rochester, Minnesota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John P Albright
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Annunziato Ned Amendola
- Duke University, Durham, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jack T Andrish
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher C Annunziata
- Commonwealth Orthopaedics & Rehabilitation, Arlington, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bernard R Bach
- Rush University Medical Center, Chicago, Illinois, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Champ L Baker
- The Hughston Clinic, Columbus, Georgia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arthur R Bartolozzi
- 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffery R Bechler
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey H Berg
- Town Center Orthopaedic Associates, Reston, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Geoffrey A Bernas
- State University of New York at Buffalo, Buffalo, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen F Brockmeier
- University of Virginia, Charlottesville, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert H Brophy
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles A Bush-Joseph
- Rush University Medical Center, Chicago, Illinois, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - J Brad Butler V
- Orthopedic and Fracture Clinic, Portland, Oregon, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John D Campbell
- Bridger Orthopedic and Sports Medicine, Bozeman, Montana, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James L Carey
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James E Carpenter
- University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan M Cooper
- HealthPartners Specialty Center, Saint Paul, Minnesota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles L Cox
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - R Alexander Creighton
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Diane L Dahm
- Mayo Clinic, Rochester, Minnesota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tal S David
- Synergy Specialists Medical Group, San Diego, California, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David C Flanigan
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert W Frederick
- The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth A Garofoli
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles J Gatt
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven R Gecha
- Princeton Orthopaedic Associates, Princeton, New Jersey, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sharon L Hame
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jo A Hannafin
- Hospital for Special Surgery, New York, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher D Harner
- University of Texas Health Center, Houston, Texas, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Norman Lindsay Harris
- Grand River Health, Rifle, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keith S Hechtman
- UHZ Sports Medicine Institute, Coral Gables, Florida, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elliott B Hershman
- Lenox Hill Hospital, New York, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rudolf G Hoellrich
- Slocum Research and Education Foundation, Eugene, Oregon, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David C Johnson
- National Sports Medicine Institute, Leesburg, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Timothy S Johnson
- National Sports Medicine Institute, Leesburg, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Morgan H Jones
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher C Kaeding
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ganesh V Kamath
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas E Klootwyk
- Methodist Sports Medicine, Indianapolis, Indiana, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bruce A Levy
- Mayo Clinic, Rochester, Minnesota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - C Benjamin Ma
- University of California, San Francisco, California, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - G Peter Maiers
- Methodist Sports Medicine Center, Indianapolis, Indiana, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew J Matava
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gregory M Mathien
- Knoxville Orthopaedic Clinic, Knoxville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David R McAllister
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric C McCarty
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert G McCormack
- University of British Columbia/Fraser Health Authority, New Westminster, British Columbia, Canada
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bruce S Miller
- University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carl W Nissen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel F O'Neill
- Littleton Regional Healthcare, Littleton, New Hampshire, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brett D Owens
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard D Parker
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark L Purnell
- Aspen Orthopedic Associates, Aspen, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arun J Ramappa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael A Rauh
- State University of New York at Buffalo, Buffalo, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arthur C Rettig
- Methodist Sports Medicine, Indianapolis, Indiana, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jon K Sekiya
- University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin G Shea
- Intermountain Orthopaedics, Boise, Idaho, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Orrin H Sherman
- NYU Hospital for Joint Diseases, New York, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James R Slauterbeck
- University of South Alabama, Mobile, Alabama, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew V Smith
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey T Spang
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ltc Steven J Svoboda
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Timothy N Taft
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joachim J Tenuta
- Albany Medical Center, Albany, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Edwin M Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Armando F Vidal
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Darius G Viskontas
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard A White
- Fitzgibbon's Hospital, Marshall, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James S Williams
- Cleveland Clinic, Euclid, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michelle L Wolcott
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James J York
- Orthopaedic and Sports Medicine Center, LLC, Pasadena, Maryland, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
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5
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Brophy RH, Wright RW, Huston LJ, Haas AK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Mann B, Spindler KP, Stuart MJ, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Bush-Joseph CA, Butler JBV, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Alexander Creighton R, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Benjamin Ma C, Peter Maiers G, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Li X, Slauterbeck JR, Smith MV, Spang JT, Svoboda LSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Rate of infection following revision anterior cruciate ligament reconstruction and associated patient- and surgeon-dependent risk factors: Retrospective results from MOON and MARS data collected from 2002 to 2011. J Orthop Res 2021; 39:274-280. [PMID: 33002248 PMCID: PMC7854959 DOI: 10.1002/jor.24871] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/08/2020] [Accepted: 09/14/2020] [Indexed: 02/04/2023]
Abstract
Infection is a rare occurrence after revision anterior cruciate ligament reconstruction (rACLR). Because of the low rates of infection, it has been difficult to identify risk factors for infection in this patient population. The purpose of this study was to report the rate of infection following rACLR and assess whether infection is associated with patient- and surgeon-dependent risk factors. We reviewed two large prospective cohorts to identify patients with postoperative infections following rACLR. Age, sex, body mass index (BMI), smoking status, history of diabetes, and graft choice were recorded for each patient. The association of these factors with postoperative infection following rACLR was assessed. There were 1423 rACLR cases in the combined cohort, with 9 (0.6%) reporting postoperative infections. Allografts had a higher risk of infection than autografts (odds ratio, 6.8; 95% CI, 0.9-54.5; p = .045). Diabetes (odds ratio, 28.6; 95% CI, 5.5-149.9; p = .004) was a risk factor for infection. Patient age, sex, BMI, and smoking status were not associated with risk of infection after rACLR.
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Affiliation(s)
- Robert H Brophy
- Washington University in St. Louis, St. Louis, Missouri, USA
| | | | | | - Amanda K Haas
- Washington University in St. Louis, St. Louis, Missouri, USA
| | - Christina R Allen
- University of California, San Francisco, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | | | | | - Arthur R Bartolozzi
- Bat Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | | | | | - Jeffrey H Berg
- Town Center Orthopaedic Associates, Reston, Virginia, USA
| | | | | | | | | | - John D Campbell
- Bridger Orthopedic and Sports Medicine, Bozeman, Montana, USA
| | - James L Carey
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, USA
| | | | | | | | | | - Tal S David
- Synergy Specialists Medical Group, San Diego, California, USA
| | | | - Robert W Frederick
- The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Charles J Gatt
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
| | - Steven R Gecha
- Princeton Orthopaedic Associates, Princeton, New Jersey, USA
| | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
| | - Sharon L Hame
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Jo A Hannafin
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | | | | | - Timothy M Hosea
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
| | | | | | | | | | - Ganesh V Kamath
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | | | | | | | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | - Eric C McCarty
- School of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Robert G McCormack
- University of British Columbia/Fraser Health Authority, British Columbia, Canada
| | | | - Carl W Nissen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | | | - Brett D Owens
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | | | | | - Arun J Ramappa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael A Rauh
- State University of New York at Buffalo, Buffalo, New York, USA
| | | | - Jon K Sekiya
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Xulei Li
- Vanderbilt University, Nashville, Tennessee, USA
| | - James R Slauterbeck
- Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Matthew V Smith
- Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jeffrey T Spang
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Ltc Steven J Svoboda
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
| | - Timothy N Taft
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | - Edwin M Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, WA, USA
| | - Armando F Vidal
- School of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | | | | | | | - Michelle L Wolcott
- School of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa, Iowa, USA
| | - James J York
- Orthopaedic and Sports Medicine Center, LLC, Pasedena, Maryland, USA
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Wright RW, Huston LJ, Haas AK, Nwosu SK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Mann B, Spindler KP, Stuart MJ, Pennings JS, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Steven J Svoboda L, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Meniscal Repair in the Setting of Revision Anterior Cruciate Ligament Reconstruction: Results From the MARS Cohort. Am J Sports Med 2020; 48:2978-2985. [PMID: 32822238 PMCID: PMC8171059 DOI: 10.1177/0363546520948850] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal preservation has been demonstrated to contribute to long-term knee health. This has been a successful intervention in patients with isolated tears and tears associated with anterior cruciate ligament (ACL) reconstruction. However, the results of meniscal repair in the setting of revision ACL reconstruction have not been documented. PURPOSE To examine the prevalence and 2-year operative success rate of meniscal repairs in the revision ACL setting. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS All cases of revision ACL reconstruction with concomitant meniscal repair from a multicenter group between 2006 and 2011 were selected. Two-year follow-up was obtained by phone and email to determine whether any subsequent surgery had occurred to either knee since the initial revision ACL reconstruction. If so, operative reports were obtained, whenever possible, to verify the pathologic condition and subsequent treatment. RESULTS In total, 218 patients (18%) from 1205 revision ACL reconstructions underwent concurrent meniscal repairs. There were 235 repairs performed: 153 medial, 48 lateral, and 17 medial and lateral. The majority of these repairs (n = 178; 76%) were performed with all-inside techniques. Two-year surgical follow-up was obtained on 90% (197/218) of the cohort. Overall, the meniscal repair failure rate was 8.6% (17/197) at 2 years. Of the 17 failures, 15 were medial (13 all-inside, 2 inside-out) and 2 were lateral (both all-inside). Four medial failures were treated in conjunction with a subsequent repeat revision ACL reconstruction. CONCLUSION Meniscal repair in the revision ACL reconstruction setting does not have a high failure rate at 2-year follow-up. Failure rates for medial and lateral repairs were both <10% and consistent with success rates of primary ACL reconstruction meniscal repair. Medial tears underwent reoperation for failure at a significantly higher rate than lateral tears.
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7
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Wright RW, Huston LJ, Haas AK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Mann B, Spindler KP, Stuart MJ, Nwosu SK, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Brad Butler V J, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Predictors of Patient-Reported Outcomes at 2 Years After Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2019; 47:2394-2401. [PMID: 31318611 PMCID: PMC7335592 DOI: 10.1177/0363546519862279] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are a valid measure of results after revision anterior cruciate ligament (ACL) reconstruction. Revision ACL reconstruction has been documented to have worse outcomes when compared with primary ACL reconstruction. Understanding positive and negative predictors of PROs will allow surgeons to modify and potentially improve outcome for patients. PURPOSE/HYPOTHESIS The purpose was to describe PROs after revision ACL reconstruction and test the hypothesis that patient- and technique-specific variables are associated with these outcomes. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients undergoing revision ACL reconstruction were identified and prospectively enrolled by 83 surgeons over 52 sites. Data included baseline demographics, surgical technique and pathology, and a series of validated PRO instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale. Patients were followed up at 2 years and asked to complete the identical set of outcome instruments. Multivariate regression models were used to control for a variety of demographic and surgical factors to determine the positive and negative predictors of PRO scores at 2 years after revision surgery. RESULTS A total of 1205 patients met the inclusion criteria and were successfully enrolled: 697 (58%) were male, with a median cohort age of 26 years. The median time since their most recent previous ACL reconstruction was 3.4 years. Two-year questionnaire follow-up was obtained from 989 patients (82%). The most significant positive predictors of 2-year IKDC scores were a high baseline IKDC score, high baseline Marx activity level, male sex, and having a longer time since the most recent previous ACL reconstruction, while negative predictors included having a lateral meniscectomy before the revision ACL reconstruction or having grade 3/4 chondrosis in either the trochlear groove or the medial tibial plateau at the time of the revision surgery. For KOOS, having a high baseline score and having a longer time between the most recent previous ACL reconstruction and revision surgery were significant positive predictors for having a better (ie, higher) 2-year KOOS, while having a lateral meniscectomy before the revision ACL reconstruction was a consistent predictor for having a significantly worse (ie, lower) 2-year KOOS. Statistically significant positive predictors for 2-year Marx activity levels included higher baseline Marx activity levels, younger age, male sex, and being a nonsmoker. Negative 2-year activity level predictors included having an allograft or a biologic enhancement at the time of revision surgery. CONCLUSION PROs after revision ACL reconstruction are associated with a variety of patient- and surgeon-related variables. Understanding positive and negative predictors of PROs will allow surgeons to guide patient expectations as well as potentially improve outcomes.
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8
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Bigouette JP, Owen EC, Lantz B(BA, Hoellrich RG, Huston LJ, Haas AK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Mann B, Spindler KP, Stuart MJ, Wright RW, Albright JP, Amendola A(N, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Relationship Between Sports Participation After Revision Anterior Cruciate Ligament Reconstruction and 2-Year Patient-Reported Outcome Measures. Am J Sports Med 2019; 47:2056-2066. [PMID: 31225999 PMCID: PMC6939628 DOI: 10.1177/0363546519856348] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) revision cohorts continually report lower outcome scores on validated knee questionnaires than primary ACL cohorts at similar time points after surgery. It is unclear how these outcomes are associated with physical activity after physician clearance for return to recreational or competitive sports after ACL revision surgery. HYPOTHESES Participants who return to either multiple sports or a singular sport after revision ACL surgery will report decreased knee symptoms, increased activity level, and improved knee function as measured by validated patient-reported outcome measures (PROMs) and compared with no sports participation. Multisport participation as compared with singular sport participation will result in similar increased PROMs and activity level. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 1205 patients who underwent revision ACL reconstruction were enrolled by 83 surgeons at 52 clinical sites. At the time of revision, baseline data collected included the following: demographics, surgical characteristics, previous knee treatment and PROMs, the International Knee Documentation Committee (IKDC) questionnaire, Marx activity score, Knee injury and Osteoarthritis Outcome Score (KOOS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). A series of multivariate regression models were used to evaluate the association of IKDC, KOOS, WOMAC, and Marx Activity Rating Scale scores at 2 years after revision surgery by sports participation category, controlling for known significant covariates. RESULTS Two-year follow-up was obtained on 82% (986 of 1205) of the original cohort. Patients who reported not participating in sports after revision surgery had lower median PROMs both at baseline and at 2 years as compared with patients who participated in either a single sport or multiple sports. Significant differences were found in the change of scores among groups on the IKDC (P < .0001), KOOS-Symptoms (P = .01), KOOS-Sports and Recreation (P = .04), and KOOS-Quality of Life (P < .0001). Patients with no sports participation were 2.0 to 5.7 times more likely than multiple-sport participants to report significantly lower PROMs, depending on the specific outcome measure assessed, and 1.8 to 3.8 times more likely than single-sport participants (except for WOMAC-Stiffness, P = .18), after controlling for known covariates. CONCLUSION Participation in either a single sport or multiple sports in the 2 years after ACL revision surgery was found to be significantly associated with higher PROMs across multiple validated self-reported assessment tools. During follow-up appointments, surgeons should continue to expect that patients who report returning to physical activity after surgery will self-report better functional outcomes, regardless of baseline activity levels.
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Affiliation(s)
| | - John P. Bigouette
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Erin C. Owen
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Brett (Brick) A. Lantz
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Rudolf G. Hoellrich
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Laura J. Huston
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Amanda K. Haas
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Christina R. Allen
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Allen F. Anderson
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Daniel E. Cooper
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Thomas M. DeBerardino
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Warren R. Dunn
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Barton Mann
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Kurt P. Spindler
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Michael J. Stuart
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Rick W. Wright
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - John P. Albright
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | | | - Jack T. Andrish
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | | | - Robert A. Arciero
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Bernard R. Bach
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Champ L. Baker
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Arthur R. Bartolozzi
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Keith M. Baumgarten
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jeffery R. Bechler
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jeffrey H. Berg
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Geoffrey A. Bernas
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Stephen F. Brockmeier
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Robert H. Brophy
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Charles A. Bush-Joseph
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - J. Brad Butler
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - John D. Campbell
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James L. Carey
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James E. Carpenter
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Brian J. Cole
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jonathan M. Cooper
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Charles L. Cox
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - R. Alexander Creighton
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Diane L. Dahm
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Tal S. David
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - David C. Flanigan
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Robert W. Frederick
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Theodore J. Ganley
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Elizabeth A. Garofoli
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Charles J. Gatt
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Steven R. Gecha
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James Robert Giffin
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Sharon L. Hame
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jo A. Hannafin
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Christopher D. Harner
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Norman Lindsay Harris
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Keith S. Hechtman
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Elliott B. Hershman
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Timothy M. Hosea
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - David C. Johnson
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Timothy S. Johnson
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Morgan H. Jones
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Christopher C. Kaeding
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Ganesh V. Kamath
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Thomas E. Klootwyk
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Bruce A. Levy
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - C. Benjamin Ma
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - G. Peter Maiers
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Robert G. Marx
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Matthew J. Matava
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Gregory M. Mathien
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - David R. McAllister
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Eric C. McCarty
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Robert G. McCormack
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Bruce S. Miller
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Carl W. Nissen
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Daniel F. O’Neill
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Brett D. Owens
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Richard D. Parker
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Mark L. Purnell
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Arun J. Ramappa
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Michael A. Rauh
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Arthur C. Rettig
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jon K. Sekiya
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Kevin G. Shea
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Orrin H. Sherman
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James R. Slauterbeck
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Matthew V. Smith
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jeffrey T. Spang
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Steven J. Svoboda
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Timothy N. Taft
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Joachim J. Tenuta
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Edwin M. Tingstad
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Armando F. Vidal
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Darius G. Viskontas
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Richard A. White
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James S. Williams
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Michelle L. Wolcott
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Brian R. Wolf
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James J. York
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
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9
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Cooper DE, Dunn WR, Huston LJ, Haas AK, Spindler KP, Allen CR, Anderson AF, DeBerardino TM, Lantz B(BA, Mann B, Stuart MJ, Albright JP, Amendola A(N, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ, Wright RW. Physiologic Preoperative Knee Hyperextension Is a Predictor of Failure in an Anterior Cruciate Ligament Revision Cohort: A Report From the MARS Group. Am J Sports Med 2018; 46:2836-2841. [PMID: 29882693 PMCID: PMC6170681 DOI: 10.1177/0363546518777732] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The occurrence of physiologic knee hyperextension (HE) in the revision anterior cruciate ligament reconstruction (ACLR) population and its effect on outcomes have yet to be reported. Hypothesis/Purpose: The prevalence of knee HE in revision ACLR and its effect on 2-year outcome were studied with the hypothesis that preoperative physiologic knee HE ≥5° is a risk factor for anterior cruciate ligament (ACL) graft rupture. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients undergoing revision ACLR were identified and prospectively enrolled between 2006 and 2011. Study inclusion criteria were patients undergoing single-bundle graft reconstructions. Patients were followed up at 2 years and asked to complete an identical set of outcome instruments (International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, WOMAC, and Marx Activity Rating Scale) as well as provide information regarding revision ACL graft failure. A regression model with graft failure as the dependent variable included age, sex, graft type at the time of the revision ACL surgery, and physiologic preoperative passive HE ≥5° (yes/no) to assess these as potential risk factors for clinical outcomes 2 years after revision ACLR. RESULTS Analyses included 1145 patients, for whom 2-year follow-up was attained for 91%. The median age was 26 years, with age being a continuous variable. Those below the median were grouped as "younger" and those above as "older" (age: interquartile range = 20, 35 years), and 42% of patients were female. There were 50% autografts, 48% allografts, and 2% that had a combination of autograft plus allograft. Passive knee HE ≥5° was present in 374 (33%) patients in the revision cohort, with 52% being female. Graft rupture at 2-year follow-up occurred in 34 cases in the entire cohort, of which 12 were in the HE ≥5° group (3.2% failure rate) and 22 in the non-HE group (2.9% failure rate). The median age of patients who failed was 19 years, as opposed to 26 years for those with intact grafts. Three variables in the regression model were significant predictors of graft failure: younger age (odds ratio [OR] = 3.6; 95% CI, 1.6-7.9; P = .002), use of allograft (OR = 3.3; 95% CI, 1.5-7.4; P = .003), and HE ≥5° (OR = 2.12; 95% CI, 1.1-4.7; P = .03). CONCLUSION This study revealed that preoperative physiologic passive knee HE ≥5° is present in one-third of patients who undergo revision ACLR. HE ≥5° was an independent significant predictor of graft failure after revision ACLR with a >2-fold OR of subsequent graft rupture in revision ACL surgery. Registration: NCT00625885 ( ClinicalTrials.gov identifier).
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Affiliation(s)
| | - Daniel E. Cooper
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Warren R. Dunn
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Laura J. Huston
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Amanda K. Haas
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Kurt P. Spindler
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Christina R. Allen
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Allen F. Anderson
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Thomas M. DeBerardino
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Brett (Brick) A. Lantz
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Barton Mann
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Michael J. Stuart
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - John P. Albright
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Annunziato (Ned) Amendola
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jack T. Andrish
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Christopher C. Annunziata
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Robert A. Arciero
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Bernard R. Bach
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Champ L. Baker
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Arthur R. Bartolozzi
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Keith M. Baumgarten
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jeffery R. Bechler
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jeffrey H. Berg
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Geoffrey A. Bernas
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Stephen F. Brockmeier
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Robert H. Brophy
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Charles A. Bush-Joseph
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - J. Brad Butler V
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - John D. Campbell
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James L. Carey
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James E. Carpenter
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Brian J. Cole
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jonathan M. Cooper
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Charles L. Cox
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - R. Alexander Creighton
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Diane L. Dahm
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Tal S. David
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - David C. Flanigan
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Robert W. Frederick
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Theodore J. Ganley
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Elizabeth A. Garofoli
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Charles J. Gatt
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Steven R. Gecha
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James Robert Giffin
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Sharon L. Hame
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jo A. Hannafin
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Christopher D. Harner
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Norman Lindsay Harris
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Keith S. Hechtman
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Elliott B. Hershman
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Rudolf G. Hoellrich
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Timothy M. Hosea
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - David C. Johnson
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Timothy S. Johnson
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Morgan H. Jones
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Christopher C. Kaeding
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Ganesh V. Kamath
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Thomas E. Klootwyk
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Bruce A. Levy
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - C. Benjamin Ma
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - G. Peter Maiers
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Robert G. Marx
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Matthew J. Matava
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Gregory M. Mathien
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - David R. McAllister
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Eric C. McCarty
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Robert G. McCormack
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Bruce S. Miller
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Carl W. Nissen
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Daniel F. O’Neill
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Brett D. Owens
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Richard D. Parker
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Mark L. Purnell
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Arun J. Ramappa
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Michael A. Rauh
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Arthur C. Rettig
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jon K. Sekiya
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Kevin G. Shea
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Orrin H. Sherman
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James R. Slauterbeck
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Matthew V. Smith
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jeffrey T. Spang
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Steven J. Svoboda
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Timothy N. Taft
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Joachim J. Tenuta
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Edwin M. Tingstad
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Armando F. Vidal
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Darius G. Viskontas
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Richard A. White
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James S. Williams
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Michelle L. Wolcott
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Brian R. Wolf
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James J. York
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Rick W. Wright
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
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Magnussen RA, Borchers JR, Pedroza AD, Huston LJ, Haas AK, Spindler KP, Wright RW, Kaeding CC, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz BA, Mann B, Stuart MJ, Albright JP, Amendola A, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Risk Factors and Predictors of Significant Chondral Surface Change From Primary to Revision Anterior Cruciate Ligament Reconstruction: A MOON and MARS Cohort Study. Am J Sports Med 2018; 46:557-564. [PMID: 29244532 PMCID: PMC7004295 DOI: 10.1177/0363546517741484] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Articular cartilage health is an important issue following anterior cruciate ligament (ACL) injury and primary ACL reconstruction. Factors present at the time of primary ACL reconstruction may influence the subsequent progression of articular cartilage damage. HYPOTHESIS Larger meniscus resection at primary ACL reconstruction, increased patient age, and increased body mass index (BMI) are associated with increased odds of worsened articular cartilage damage at the time of revision ACL reconstruction. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Subjects who had primary and revision data in the databases of the Multicenter Orthopaedics Outcomes Network (MOON) and Multicenter ACL Revision Study (MARS) were included. Reviewed data included chondral surface status at the time of primary and revision surgery, meniscus status at the time of primary reconstruction, primary reconstruction graft type, time from primary to revision ACL surgery, as well as demographics and Marx activity score at the time of revision. Significant progression of articular cartilage damage was defined in each compartment according to progression on the modified Outerbridge scale (increase ≥1 grade) or >25% enlargement in any area of damage. Logistic regression identified predictors of significant chondral surface change in each compartment from primary to revision surgery. RESULTS A total of 134 patients were included, with a median age of 19.5 years at revision surgery. Progression of articular cartilage damage was noted in 34 patients (25.4%) in the lateral compartment, 32 (23.9%) in the medial compartment, and 31 (23.1%) in the patellofemoral compartment. For the lateral compartment, patients who had >33% of the lateral meniscus excised at primary reconstruction had 16.9-times greater odds of progression of articular cartilage injury than those with an intact lateral meniscus ( P < .001). For the medial compartment, patients who had <33% of the medial meniscus excised at the time of the primary reconstruction had 4.8-times greater odds of progression of articular cartilage injury than those with an intact medial meniscus ( P = .02). Odds of significant chondral surface change increased by 5% in the lateral compartment and 6% in the medial compartment for each increased year of age ( P ≤ .02). For the patellofemoral compartment, the use of allograft in primary reconstruction was associated with a 15-fold increased odds of progression of articular cartilage damage relative to a patellar tendon autograft ( P < .001). Each 1-unit increase in BMI at the time of revision surgery was associated with a 10% increase in the odds of progression of articular cartilage damage ( P = .046) in the patellofemoral compartment. CONCLUSION Excision of the medial and lateral meniscus at primary ACL reconstruction increases the odds of articular cartilage damage in the corresponding compartment at the time of revision ACL reconstruction. Increased age is a risk factor for deterioration of articular cartilage in both tibiofemoral compartments, while increased BMI and the use of allograft for primary ACL reconstruction are associated with an increased risk of progression in the patellofemoral compartment.
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Affiliation(s)
| | - Robert A. Magnussen
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James R. Borchers
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Angela D. Pedroza
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Laura J. Huston
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Amanda K. Haas
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kurt P. Spindler
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rick W. Wright
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher C. Kaeding
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christina R. Allen
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Allen F. Anderson
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel E. Cooper
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas M. DeBerardino
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Warren R. Dunn
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brett A. Lantz
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Barton Mann
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael J. Stuart
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John P. Albright
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Annunziato Amendola
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jack T. Andrish
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Robert A. Arciero
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bernard R. Bach
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Champ L. Baker
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Arthur R. Bartolozzi
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Keith M. Baumgarten
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jeffery R. Bechler
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jeffrey H. Berg
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Geoffrey A. Bernas
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephen F. Brockmeier
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert H. Brophy
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Charles A. Bush-Joseph
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - J. Brad Butler
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D. Campbell
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James L. Carey
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James E. Carpenter
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brian J. Cole
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jonathan M. Cooper
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Charles L. Cox
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - R. Alexander Creighton
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Diane L. Dahm
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tal S. David
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David C. Flanigan
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert W. Frederick
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Theodore J. Ganley
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Elizabeth A. Garofoli
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Charles J. Gatt
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven R. Gecha
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James Robert Giffin
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sharon L. Hame
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jo A. Hannafin
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher D. Harner
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Norman Lindsay Harris
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Keith S. Hechtman
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Elliott B. Hershman
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rudolf G. Hoellrich
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Timothy M. Hosea
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David C. Johnson
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Timothy S. Johnson
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Morgan H. Jones
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ganesh V. Kamath
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas E. Klootwyk
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bruce A. Levy
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - C. Benjamin Ma
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - G. Peter Maiers
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert G. Marx
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew J. Matava
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Gregory M. Mathien
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David R. McAllister
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Eric C. McCarty
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert G. McCormack
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bruce S. Miller
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Carl W. Nissen
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel F. O’Neill
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brett D. Owens
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard D. Parker
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mark L. Purnell
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Arun J. Ramappa
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael A. Rauh
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Arthur C. Rettig
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jon K. Sekiya
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kevin G. Shea
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Orrin H. Sherman
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James R. Slauterbeck
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew V. Smith
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jeffrey T. Spang
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven J. Svoboda
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Timothy N. Taft
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Joachim J. Tenuta
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Edwin M. Tingstad
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Armando F. Vidal
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Darius G. Viskontas
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard A. White
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James S. Williams
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michelle L. Wolcott
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brian R. Wolf
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James J. York
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Haas AK, Huston LJ, Lantz B(BA, Mann B, Nwosu SK, Spindler KP, Stuart MJ, Wright RW, Albright JP, Amendola A(N, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LTCSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Surgical Predictors of Clinical Outcomes After Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2017; 45:2586-2594. [PMID: 28696164 PMCID: PMC5675127 DOI: 10.1177/0363546517712952] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Revision anterior cruciate ligament (ACL) reconstruction has been documented to have worse outcomes compared with primary ACL reconstruction. HYPOTHESIS Certain factors under the control of the surgeon at the time of revision surgery can both negatively and positively affect outcomes. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Patients undergoing revision ACL reconstruction were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, intraoperative surgical technique and joint disorders, and a series of validated patient-reported outcome instruments (International Knee Documentation Committee [IKDC] subjective form, Knee Injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], and Marx activity rating scale) completed before surgery. Patients were followed up for 2 years and asked to complete an identical set of outcome instruments. Regression analysis was used to control for age, sex, body mass index (BMI), activity level, baseline outcome scores, revision number, time since last ACL reconstruction, and a variety of previous and current surgical variables to assess the surgical risk factors for clinical outcomes 2 years after revision ACL reconstruction. RESULTS A total of 1205 patients (697 male [58%]) met the inclusion criteria and were successfully enrolled. The median age was 26 years, and the median time since their last ACL reconstruction was 3.4 years. Two-year follow-up was obtained on 82% (989/1205). Both previous and current surgical factors were found to be significant contributors toward poorer clinical outcomes at 2 years. Having undergone previous arthrotomy (nonarthroscopic open approach) for ACL reconstruction compared with the 1-incision technique resulted in significantly poorer outcomes for the 2-year IKDC ( P = .037; odds ratio [OR], 2.43; 95% CI, 1.05-5.88) and KOOS pain, sports/recreation, and quality of life (QOL) subscales ( P ≤ .05; OR range, 2.38-4.35; 95% CI, 1.03-10.00). The use of a metal interference screw for current femoral fixation resulted in significantly better outcomes for the 2-year KOOS symptoms, pain, and QOL subscales ( P ≤ .05; OR range, 1.70-1.96; 95% CI, 1.00-3.33) as well as WOMAC stiffness subscale ( P = .041; OR, 1.75; 95% CI, 1.02-3.03). Not performing notchplasty at revision significantly improved 2-year outcomes for the IKDC ( P = .013; OR, 1.47; 95% CI, 1.08-1.99), KOOS activities of daily living (ADL) and QOL subscales ( P ≤ .04; OR range, 1.40-1.41; 95% CI, 1.03-1.93), and WOMAC stiffness and ADL subscales ( P ≤ .04; OR range, 1.41-1.49; 95% CI, 1.03-2.05). Factors before revision ACL reconstruction that increased the risk of poorer clinical outcomes at 2 years included lower baseline outcome scores, a lower Marx activity score at the time of revision, a higher BMI, female sex, and a shorter time since the patient's last ACL reconstruction. Prior femoral fixation, prior femoral tunnel aperture position, and knee flexion angle at the time of revision graft fixation were not found to affect 2-year outcomes in this revision cohort. CONCLUSION There are certain surgical variables that the physician can control at the time of revision ACL reconstruction that can modify clinical outcomes at 2 years. Whenever possible, opting for an anteromedial portal or transtibial surgical exposure, choosing a metal interference screw for femoral fixation, and not performing notchplasty are associated with significantly better 2-year clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tal S. David
- Synergy Specialists Medical Group, San Diego, CA USA
| | | | | | | | | | | | | | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London Ontario, Canada
| | - Sharon L. Hame
- David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | | | | | | | | | | | | | | | | | | | | | | | - Ganesh V. Kamath
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | | | | | | | | | | | | | | | - Eric C. McCarty
- University of Colorado Denver School of Medicine, Denver, CO USA
| | | | | | | | | | - Brett D. Owens
- Warren Alpert Medical School, Brown University, Providence, RI USA
| | | | | | | | | | | | | | | | | | | | | | - Jeffrey T. Spang
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | - Timothy N. Taft
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | - Edwin M. Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, WA USA
| | - Armando F. Vidal
- University of Colorado Denver School of Medicine, Denver, CO USA
| | | | | | | | | | - Brian R. Wolf
- University of Iowa Hospitals and Clinics, Iowa City, IA USA
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12
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Ding DY, Zhang AL, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Haas AK, Huston LJ, Lantz BBA, Mann B, Spindler KP, Stuart MJ, Wright RW, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Subsequent Surgery After Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors From a Multicenter Cohort. Am J Sports Med 2017; 45:2068-2076. [PMID: 28557557 PMCID: PMC5513777 DOI: 10.1177/0363546517707207] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While revision anterior cruciate ligament reconstruction (ACLR) can be performed to restore knee stability and improve patient activity levels, outcomes after this surgery are reported to be inferior to those after primary ACLR. Further reoperations after revision ACLR can have an even more profound effect on patient satisfaction and outcomes. However, there is a current lack of information regarding the rate and risk factors for subsequent surgery after revision ACLR. PURPOSE To report the rate of reoperations, procedures performed, and risk factors for a reoperation 2 years after revision ACLR. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A total of 1205 patients who underwent revision ACLR were enrolled in the Multicenter ACL Revision Study (MARS) between 2006 and 2011, composing the prospective cohort. Two-year questionnaire follow-up was obtained for 989 patients (82%), while telephone follow-up was obtained for 1112 patients (92%). If a patient reported having undergone subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Multivariate regression analysis was performed to determine independent risk factors for a reoperation. RESULTS Of the 1112 patients included in the analysis, 122 patients (11%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperations, 27% were meniscal procedures (69% meniscectomy, 26% repair), 19% were subsequent revision ACLR, 17% were cartilage procedures (61% chondroplasty, 17% microfracture, 13% mosaicplasty), 11% were hardware removal, and 9% were procedures for arthrofibrosis. Multivariate analysis revealed that patients aged <20 years had twice the odds of patients aged 20 to 29 years to undergo a reoperation. The use of an allograft at the time of revision ACLR (odds ratio [OR], 1.79; P = .007) was a significant predictor for reoperations at 2 years, while staged revision (bone grafting of tunnels before revision ACLR) (OR, 1.93; P = .052) did not reach significance. Patients with grade 4 cartilage damage seen during revision ACLR were 78% less likely to undergo subsequent operations within 2 years. Sex, body mass index, smoking history, Marx activity score, technique for femoral tunnel placement, and meniscal tearing or meniscal treatment at the time of revision ACLR showed no significant effect on the reoperation rate. CONCLUSION There was a significant reoperation rate after revision ACLR at 2 years (11%), with meniscal procedures most commonly involved. Independent risk factors for subsequent surgery on the ipsilateral knee included age <20 years and the use of allograft tissue at the time of revision ACLR.
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Affiliation(s)
- MARS Group
- Department of Orthopaedic Surgery, University of California San Francisco
| | | | - Alan L Zhang
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Christina R Allen
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Allen F Anderson
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Daniel E Cooper
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Thomas M DeBerardino
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Warren R Dunn
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Amanda K Haas
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Laura J Huston
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brett Brick A Lantz
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Barton Mann
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Kurt P Spindler
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael J Stuart
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Rick W Wright
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - John P Albright
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Annunziato Ned Amendola
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jack T Andrish
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Christopher C Annunziata
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Robert A Arciero
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Bernard R Bach
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Champ L Baker
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Arthur R Bartolozzi
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Keith M Baumgarten
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jeffery R Bechler
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey H Berg
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Geoffrey A Bernas
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Stephen F Brockmeier
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Robert H Brophy
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Charles A Bush-Joseph
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - J Brad Butler
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - John D Campbell
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - James L Carey
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - James E Carpenter
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brian J Cole
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jonathan M Cooper
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Charles L Cox
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - R Alexander Creighton
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Diane L Dahm
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Tal S David
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - David C Flanigan
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Robert W Frederick
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Theodore J Ganley
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Elizabeth A Garofoli
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Charles J Gatt
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Steven R Gecha
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - James Robert Giffin
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Sharon L Hame
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jo A Hannafin
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Christopher D Harner
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Norman Lindsay Harris
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Keith S Hechtman
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Elliott B Hershman
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Rudolf G Hoellrich
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Timothy M Hosea
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - David C Johnson
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Timothy S Johnson
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Morgan H Jones
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Christopher C Kaeding
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Ganesh V Kamath
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Thomas E Klootwyk
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Bruce A Levy
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - C Benjamin Ma
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - G Peter Maiers
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Robert G Marx
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Matthew J Matava
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Gregory M Mathien
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - David R McAllister
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Eric C McCarty
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Robert G McCormack
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Bruce S Miller
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Carl W Nissen
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Daniel F O'Neill
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brett D Owens
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Richard D Parker
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Mark L Purnell
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Arun J Ramappa
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael A Rauh
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Arthur C Rettig
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jon K Sekiya
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Kevin G Shea
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Orrin H Sherman
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - James R Slauterbeck
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Matthew V Smith
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey T Spang
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Steven J Svoboda
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Timothy N Taft
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Joachim J Tenuta
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Edwin M Tingstad
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Armando F Vidal
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Darius G Viskontas
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Richard A White
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - James S Williams
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Michelle L Wolcott
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brian R Wolf
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - James J York
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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Wright RW, Huston LJ, Haas AK, Spindler KP, Nwosu SK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz B(BA, Stuart MJ, Garofoli EA, Albright JP, Amendola A(N, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Effect of graft choice on the outcome of revision anterior cruciate ligament reconstruction in the Multicenter ACL Revision Study (MARS) Cohort. Am J Sports Med 2014; 42:2301-10. [PMID: 25274353 PMCID: PMC4447184 DOI: 10.1177/0363546514549005] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Most surgeons believe that graft choice for anterior cruciate ligament (ACL) reconstruction is an important factor related to outcome; however, graft choice for revision may be limited due to previously used grafts. HYPOTHESES Autograft use would result in increased sports function, increased activity level, and decreased osteoarthritis symptoms (as measured by validated patient-reported outcome instruments). Autograft use would result in decreased graft failure and reoperation rate 2 years after revision ACL reconstruction. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients undergoing revision ACL reconstruction were identified and prospectively enrolled by 83 surgeons at 52 sites. Data collected included baseline demographics, surgical technique, pathologic abnormalities, and the results of a series of validated, patient-reported outcome instruments (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], and Marx activity rating score). Patients were followed up at 2 years and asked to complete the identical set of outcome instruments. Incidences of additional surgery and reoperation due to graft failure were also recorded. Multivariate regression models were used to determine the predictors (risk factors) of IKDC, KOOS, WOMAC, Marx scores, graft rerupture, and reoperation rate at 2 years after revision surgery. RESULTS A total of 1205 patients (697 [58%] males) were enrolled. The median age was 26 years. In 88% of patients, this was their first revision, and 341 patients (28%) were undergoing revision by the surgeon who had performed the previous reconstruction. The median time since last ACL reconstruction was 3.4 years. Revision using an autograft was performed in 583 patients (48%), allograft was used in 590 (49%), and both types were used in 32 (3%). Questionnaire follow-up was obtained for 989 subjects (82%), while telephone follow-up was obtained for 1112 (92%). The IKDC, KOOS, and WOMAC scores (with the exception of the WOMAC stiffness subscale) all significantly improved at 2-year follow-up (P < .001). In contrast, the 2-year Marx activity score demonstrated a significant decrease from the initial score at enrollment (P < .001). Graft choice proved to be a significant predictor of 2-year IKDC scores (P = .017). Specifically, the use of an autograft for revision reconstruction predicted improved score on the IKDC (P = .045; odds ratio [OR] = 1.31; 95% CI, 1.01-1.70). The use of an autograft predicted an improved score on the KOOS sports and recreation subscale (P = .037; OR = 1.33; 95% CI, 1.02-1.73). Use of an autograft also predicted improved scores on the KOOS quality of life subscale (P = .031; OR = 1.33; 95% CI, 1.03-1.73). For the KOOS symptoms and KOOS activities of daily living subscales, graft choice did not predict outcome score. Graft choice was a significant predictor of 2-year Marx activity level scores (P = .012). Graft rerupture was reported in 37 of 1112 patients (3.3%) by their 2-year follow-up: 24 allografts, 12 autografts, and 1 allograft and autograft. Use of an autograft for revision resulted in patients being 2.78 times less likely to sustain a subsequent graft rupture compared with allograft (P = .047; 95% CI, 1.01-7.69). CONCLUSION Improved sports function and patient-reported outcome measures are obtained when an autograft is used. Additionally, use of an autograft shows a decreased risk in graft rerupture at 2-year follow-up. No differences were noted in rerupture or patient-reported outcomes between soft tissue and bone-patellar tendon-bone grafts. Surgeon education regarding the findings of this study has the potential to improve the results of revision ACL reconstruction.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tal S. David
- Arthroscopic and Orthopedic Sports Medicine Associates
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Brett D. Owens
- Keller Army Community Hospital-United States Military Academy
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Abstract
The influence of training adaptations, induced within the active muscles of rats with peripheral arterial insufficiency, was assessed with an isolated hindlimb preparation. Femoral artery-stenosed rats, showing symptoms of intermittent claudication, were trained for 14-20 wk by running at 20-35 m/min up a 15% grade for up to approximately 1 h/day, 5 days/wk. Similar total hindlimb blood flows (12.6 ml/min) at a similar arterial O2 content (20.7 vol/100 ml) yielded similar blood flows (95-117 ml.min-1.100 g-1) and O2 deliveries (9-11 mumol.min-1.g-1) to the contracting muscle of sedentary (n = 10) and trained (n = 10) rats. Ten-minute periods of tetanic contractions (100 ms at 100 Hz each) at 4, 8, 13, 45, 60, and 90 tetani/min were used. Muscle force development was better maintained (P less than 0.001) by the trained group. Higher peak O2 consumption (P less than 0.01) of the trained (5.69 +/- 0.53 mumol.min-1.g-1) compared with the sedentary group (3.66 +/- 0.26 mumol.min-1.g-1) involved a greater O2 extraction, since delivery of O2 was not different between groups. Thus adaptations occurred within trained muscle to enhance performance and peak O2 consumption. Muscle citrate synthase activity, an index of mitochondrial content, was greater (P less than 0.005) in the trained group, with the low-oxidative white muscle section exhibiting the greatest change (approximately threefold sedentary). Adaptations in this section were probably realized functionally, since improvements in muscle performance were evident early in the contraction sequence.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- T P Erney
- Department of Physiology, State University of New York, Syracuse 13210
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Abstract
The influence of exercise training on the recovery of muscle blood flow was assessed in rats with bilateral stenosis of the femoral artery, sufficient to limit exercise hyperemia in the distal hindlimb but not alter resting blood flow. Muscle blood flow was measured with 141Ce-labeled microspheres (15 microns) during treadmill running at 20 m/min in normal (n = 10), acute stenosed (n = 9), sedentary stenosed (n = 10) and trained stenosed (n = 13) animals. Treadmill training by a progressively intense program (up to 1 h/day, 7 days/wk for 6 wk) improved exercise tolerance evident both in duration and intensity of exercise. Total hindlimb blood flow (ml.min-1.100 g-1) was not different (P greater than 0.05) between all stenosed groups but was only 46-63% that of the normal group (P less than 0.05). Acute stenosis reduced distal blood flow to only 22% of that in the proximal hindlimb tissue. A significant (P less than 0.05) but limited recovery of distal limb blood flow (to 44% of proximal) occurred in sedentary stenosed rats after 6 wk of cage activity. Training further increased (P less than 0.05) distal limb blood flow to 69% of proximal. This partial recovery of distal limb blood flow could reflect a greater collateral vessel function or an enhanced vascularity of the distal limb tissue. Our results illustrate that peripheral adaptations occur within the ischemic hindlimb of trained animals to redistribute the limited O2 delivery to the active muscles most affected by stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G M Mathien
- Department of Physiology, State University of New York, Health Science Center, Syracus 13210
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Abstract
A reduction in muscle blood flow caused by central vascular or peripheral vascular disease, or both, invariably leads to a reduction in exercise tolerance. Exercise conditioning programs have been shown to be an effective means of improving exercise tolerance in many patients with cardiovascular disease. However, improvements can be found without detectable changes in total muscle blood flow during activity. This suggests that peripheral adaptations induced within active muscles by exercise training exert a beneficial influence. These adaptations could include (1) a redistribution of blood flow within the active muscle or limb, or both; (2) an enhanced capillary density within the active muscle; and (3) an increased mitochondrial content within the active muscle. Evaluation of these adaptations, in an animal model of peripheral arterial insufficiency, suggests that all 3 factors potentially serve to enhance exercise tolerance after training. The improved ability of trained muscle to accommodate the metabolic stress during contractions is noteworthy. These factors could contribute to the marked increase in endurance during mild submaximal exercise observed in patients after training.
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Affiliation(s)
- R L Terjung
- Department of Physiology, State University of New York, Syracuse 13210
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17
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Abstract
The influence of training on muscle performance in situ, exercise tolerance in vivo, and muscle blood flow, was assessed in rats in which femoral arteries were previously surgically constricted to severely limit active hyperemia but not to restrict normal resting blood flow (BF). Muscle BF to the different fiber type sections of the gastrocnemius plantaris soleus muscle group was determined during in situ stimulation (15 and 30 tetani/min) using 15-microns microspheres after 0, 1, 2, 3, and 5 wk (n = 5-6/wk) of daily treadmill training. Surgical stenosis was performed 48 h prior to the initiation of training. The ability of the hindlimb muscle of sedentary stenosed animals to maintain tension in situ improved from an extensive deficit to normal at 3 wk during relatively mild contractions (15 tetani/min) but not at 5 wk during 30 tetani/min. Although BF improved to normal at 15 tetani/min, a large BF deficit remained at 30 tetani/min. Exercise tolerance during running increased approximately twofold in duration. In contrast, trained stenosed animals demonstrated normal muscle tension in situ by 2 wk during 15 tetani/min and at 5 wk during 30 tetani/min. Exercise tolerance during running increased in duration (approximately fivefold) and intensity (approximately twofold). Although BF to the entire contracting muscle mass was not different between trained and sedentary stenosed animals, its distribution within the gastrocnemius was more homogenous (P less than 0.001). This was probably due to adaptations within the fast-twitch white muscle section and could have contributed to the dramatic improvement in muscle function and exercise tolerance exhibited by the trained stenosed animals.
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Mathien GM, Terjung RL. TRAINING INDUCED BLOOD FLOW ADAPTATIONS IN A RAT MODEL OF PERIPHERAL ARTERIAL INSUFFICIENCY. Med Sci Sports Exerc 1985. [DOI: 10.1249/00005768-198504000-00448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mathien GM, Terjung RL. INFLUENCE OF TRAINING ON EXERCISE PERFORMANCE AND MUSCLE BLOOD FLOW IN RATS WITH BILATERAL STENOSIS OF THE FEMORAL ARTERY. Med Sci Sports Exerc 1983. [DOI: 10.1249/00005768-198315020-00450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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