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Anterior Cruciate Ligament Reconstruction in High School and College-Aged Athletes: Does Autograft Choice Influence Anterior Cruciate Ligament Revision Rates?

Publication ,  Journal Article
MOON Knee Group; Spindler, KP; Huston, LJ; Zajichek, A; Reinke, EK; Amendola, A; Andrish, JT; Brophy, RH; Dunn, WR; Flanigan, DC; Jones, MH ...
Published in: Am J Sports Med
February 2020

BACKGROUND: Physicians' and patients' decision-making process between bone-patellar tendon-bone (BTB) and hamstring tendon autografts for anterior cruciate ligament (ACL) reconstruction (ACLR) may be influenced by a variety of factors in the young, active athlete. PURPOSE: To determine the incidence of both ACL graft revisions and contralateral ACL tears resulting in subsequent ACLR in a cohort of high school- and college-aged athletes who initially underwent primary ACLR with either a BTB or a hamstring autograft. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Study inclusion criteria were patients aged 14 to 22 years who were injured in sports, had a contralateral normal knee, and were scheduled to undergo unilateral primary ACLR with either a BTB or a hamstring autograft. All patients were prospectively followed for 6 years to determine whether any subsequent ACLR was performed in either knee after their initial ACLR. Multivariable regression modeling controlled for age, sex, ethnicity/race, body mass index, sport and competition level, baseline activity level, knee laxity, and graft type. The 6-year outcomes were the incidence of subsequent ACLR in either knee. RESULTS: A total of 839 patients were eligible, of which 770 (92%) had 6-year follow-up for the primary outcome measure of the incidence of subsequent ACLR. The median age was 17 years, with 48% female, and the distribution of BTB and hamstring grafts was 492 (64%) and 278 (36%), respectively. The incidence of subsequent ACLR at 6 years was 9.2% in the ipsilateral knee, 11.2% in the contralateral normal knee, and 19.7% for either knee. High-grade preoperative knee laxity (odds ratio [OR], 2.4 [95% confidence interval [CI], 1.4-3.9]; P = .001), autograft type (OR, 2.1 [95% CI, 1.3-3.5]; P = .004), and age (OR, 0.8 [95% CI, 0.7-1.0]; P = .009) were the 3 most influential predictors of ACL graft revision in the ipsilateral knee. The odds of ACL graft revision were 2.1 times higher for patients receiving a hamstring autograft than patients receiving a BTB autograft (95% CI, 1.3-3.5; P = .004). No significant differences were found between autograft choices when looking at the incidence of subsequent ACLR in the contralateral knee. CONCLUSION: There was a high incidence of both ACL graft revisions and contralateral normal ACL tears resulting in subsequent ACLR in this young athletic cohort. The incidence of ACL graft revision at 6 years after index surgery was 2.1 times higher with a hamstring autograft compared with a BTB autograft.

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Published In

Am J Sports Med

DOI

EISSN

1552-3365

Publication Date

February 2020

Volume

48

Issue

2

Start / End Page

298 / 309

Location

United States

Related Subject Headings

  • Young Adult
  • Reoperation
  • Orthopedics
  • Odds Ratio
  • Male
  • Incidence
  • Humans
  • Hamstring Tendons
  • Female
  • Cohort Studies
 

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MOON Knee Group, Spindler, K. P., Huston, L. J., Zajichek, A., Reinke, E. K., Amendola, A., … Wright, R. W. (2020). Anterior Cruciate Ligament Reconstruction in High School and College-Aged Athletes: Does Autograft Choice Influence Anterior Cruciate Ligament Revision Rates? Am J Sports Med, 48(2), 298–309. https://doi.org/10.1177/0363546519892991
MOON Knee Group, Kurt P. Spindler, Laura J. Huston, Alexander Zajichek, Emily K. Reinke, Annunziato Amendola, Jack T. Andrish, et al. “Anterior Cruciate Ligament Reconstruction in High School and College-Aged Athletes: Does Autograft Choice Influence Anterior Cruciate Ligament Revision Rates?Am J Sports Med 48, no. 2 (February 2020): 298–309. https://doi.org/10.1177/0363546519892991.
MOON Knee Group, Spindler KP, Huston LJ, Zajichek A, Reinke EK, Amendola A, et al. Anterior Cruciate Ligament Reconstruction in High School and College-Aged Athletes: Does Autograft Choice Influence Anterior Cruciate Ligament Revision Rates? Am J Sports Med. 2020 Feb;48(2):298–309.
MOON Knee Group, et al. “Anterior Cruciate Ligament Reconstruction in High School and College-Aged Athletes: Does Autograft Choice Influence Anterior Cruciate Ligament Revision Rates?Am J Sports Med, vol. 48, no. 2, Feb. 2020, pp. 298–309. Pubmed, doi:10.1177/0363546519892991.
MOON Knee Group, Spindler KP, Huston LJ, Zajichek A, Reinke EK, Amendola A, Andrish JT, Brophy RH, Dunn WR, Flanigan DC, Jones MH, Kaeding CC, Marx RG, Matava MJ, McCarty EC, Parker RD, Vidal AF, Wolcott ML, Wolf BR, Wright RW. Anterior Cruciate Ligament Reconstruction in High School and College-Aged Athletes: Does Autograft Choice Influence Anterior Cruciate Ligament Revision Rates? Am J Sports Med. 2020 Feb;48(2):298–309.
Journal cover image

Published In

Am J Sports Med

DOI

EISSN

1552-3365

Publication Date

February 2020

Volume

48

Issue

2

Start / End Page

298 / 309

Location

United States

Related Subject Headings

  • Young Adult
  • Reoperation
  • Orthopedics
  • Odds Ratio
  • Male
  • Incidence
  • Humans
  • Hamstring Tendons
  • Female
  • Cohort Studies