Incidence of Subsequent Injury to Either Knee Within 5 Years After Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft

Shelbourne Knee Center, 1815 N. Capitol Avenue, Suite 530, Indianapolis, IN 46202, USA.
The American Journal of Sports Medicine (Impact Factor: 4.36). 12/2008; 37(2):246-51. DOI: 10.1177/0363546508325665
Source: PubMed


The risk of subsequent anterior cruciate ligament injury to either knee after surgery based on sex, age, and activity has not been extensively studied.
Women have a higher incidence of anterior cruciate ligament injury to the contralateral knee after surgery than men but do not have a difference in injuries to the reconstructed knee. Young, competitive athletes have a higher incidence of injury than older patients. The time to return to full activities does not affect injury rate.
Cohort study (prognosis); Level of evidence, 2.
The authors prospectively followed 1820 patients after primary anterior cruciate ligament reconstruction to determine if patients suffered an injury to either knee within 5 years after surgery. Subsequent injury was evaluated based on sex, age, and activity level.
Minimum 5-year follow-up was obtained on 1415 patients (78%). Seventy-five patients (5.3%) had an injury to the contralateral knee, and 61 patients (4.3%) suffered an injury to the reconstructed knee (P = .2185). Women suffered more injuries (7.8%) to the contralateral normal knee than men (3.7%; P < .001) but not more injuries to the reconstructed knee (4.3% vs 4.1%; P = .5543). The risk of subsequent injury to either knee was 17% for patients <18 years old, 7% for patients aged 18 to 25 years, and 4% for patients older than 25 years. There was no difference in injury rate between patients who returned before and after 6 months postoperatively.
Women have a higher incidence of anterior cruciate ligament injury to the contralateral knee than men after reconstruction. The incidence of injury to either knee after reconstruction is associated with younger age and higher activity level, but returning to full activities before 6 months postoperatively does not increase the risk of subsequent injury.

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Available from: Marc Haro, Aug 04, 2015
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    • "The aim of this surgical procedure is to restore knee stability and increase the chance to return to sports (Fink et al., 2001). However, ACL graft and contralateral ACL rupture rates are more than 10% in the general population (Salmon et al., 2005; Shelbourne et al., 2009a) and more than 20% in adolescent and young athletes who returned to the sports of soccer and basketball following ACL-R (Shelbourne et al., 2009b). One neuromuscular control risk factor that has been identified for ACL re-injury was asymmetry in sagittal plane knee joint moment during landing (Paterno et al., 2010). "
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    ABSTRACT: Asymmetries in sagittal plane knee kinetics have been identified as a risk factor for anterior cruciate ligament (ACL) re-injury. Clinical tools are needed to identify the asymmetries. This study examined the relationships between knee kinetic asymmetries and ground reaction force (GRF) asymmetries during athletic tasks in adolescent patients following ACL reconstruction (ACL-R). Kinematic and GRF data were collected during a stop-jump task and a side-cutting task for 23 patients. Asymmetry indices between the surgical and non-surgical limbs were calculated for GRF and knee kinetic variables. For the stop-jump task, knee kinetics asymmetry indices were correlated with all GRF asymmetry indices (P < 0.05), except for loading rate. Vertical GRF impulse asymmetry index predicted peak knee moment, average knee moment, and knee work (R(2) ≥ 0.78, P < 0.01) asymmetry indices. For the side-cutting tasks, knee kinetic asymmetry indices were correlated with the peak propulsion vertical GRF and vertical GRF impulse asymmetry indices (P < 0.05). Vertical GRF impulse asymmetry index predicted peak knee moment, average knee moment, and knee work (R(2) ≥ 0.55, P < 0.01) asymmetry indices. The vertical GRF asymmetries may be a viable surrogate for knee kinetic asymmetries and therefore may assist in optimizing rehabilitation outcomes and minimizing re-injury rates.
    Scandinavian Journal of Medicine and Science in Sports 09/2013; 24(6):974-981. DOI:10.1111/sms.12118 · 2.90 Impact Factor
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    • "Of particular concern following ACL reconstruction is the high reported incidence of re-rupture and subsequent knee joint injury [13] [14] [15]. Re-rupture rates of 17% for patients younger than 18 years, 7% for patients aged 18 to 25 years, and 4% for patients older than 25 years have been reported [15]. An increasing body of literature suggests that deficiencies in static and dynamic postural stability increase the risk of lower limb injury [16] [17] [18]. "
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    ABSTRACT: Previous research has used time to stabilization (TTS) from forward landing tasks to assess dynamic postural stability in ACL reconstructed (ACLR) athletes in order to identify impaired sensorimotor control and mechanical stability. This may not be an appropriate test due to the fact that research has suggested that ACL injury has a multi-planar mechanism of injury. The purpose of the present study was to compare TTS values from a forward land and a diagonal land to determine if diagonal landing TTS values are more sensitive to dynamic postural stability deficits in female ACLR athletes. A group of ACL reconstructed female athletes and a group of female control athletes performed three forward lands and three diagonal lands onto a force-plate and remained still on one foot for 15s. TTS was calculated for the anterior-posterior and medial-lateral ground reaction forces as well as the resultant vector of both forces. All three TTS values were significantly increased in the ACLR group from the control group for the diagonal landing task. There was no difference in TTS values between the groups for the forward landing task. TTS values from a diagonal landing are more sensitive at detecting impaired dynamic postural stability in a group of female ACLR athletes compared to TTS values from a forward land. III - Casecontrolled study.
    The Knee 08/2013; 20(6). DOI:10.1016/j.knee.2013.07.008 · 1.94 Impact Factor
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    • "The aim of ACL reconstruction surgery is to restore knee joint mechanical stability such that the athlete can return to sporting participation . However, full restoration of knee joint function following ACL reconstruction is often limited, and future complications such as the development of knee joint osteoarthritis (Chaudhari et al., 2008), future knee joint injury (Waldén et al., 2006) and re-rupture are of particular concern (Shelbourne et al., 2009). "
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    ABSTRACT: Anterior cruciate ligament (ACL) injury is a common injury encountered by sport medicine clinicians. Surgical reconstruction is the recommended treatment of choice for those athletes wishing to return to full-contact sports participation and for sports requiring multi-directional movement patterns. The aim of ACL reconstruction is to restore knee joint mechanical stability such that the athlete can return to sporting participation. However, knowledge regarding the extent to which lower limb kinematic profiles are restored following ACL reconstruction is limited. In the present study the hip and knee joint kinematic profiles of 13 ACL reconstructed (ACL-R) and 16 non-injured control subjects were investigated during the performance of a diagonal jump landing task. The ACL-R group exhibited significantly less peak knee joint flexion (P=0.01). Significant between group differences were noted for time averaged hip joint sagittal plane (P<0.05) and transverse plane (P<0.05) kinematic profiles, as well as knee joint frontal plane (P<0.05) and sagittal plane (P<0.05) kinematic profiles. These results suggest that aberrant hip and knee joint kinematic profiles are present following ACL reconstruction, which could influence future injury risk.
    Journal of electromyography and kinesiology: official journal of the International Society of Electrophysiological Kinesiology 04/2012; 22(4):598-606. DOI:10.1016/j.jelekin.2012.02.009 · 1.65 Impact Factor
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