Article

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: 4.7). 12/2008; 37(2):246-51. DOI: 10.1177/0363546508325665
Source: PubMed

ABSTRACT 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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    • "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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    • "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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    • "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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