Study identifies predictors of failure after ACL reconstruction in young athletes
SAN FRANCISCO — Investigators from Pittsburgh have found a 13% failure rate after anatomic ACL reconstruction using allograft in young athletes.
The findings, which were presented by Carola Francisca Van Eck, MD, at the 2011 Annual Meeting of the Arthroscopy Association of North America, noted that failure could be associated with a younger patient age, an earlier return to sport and a heavier body weight.
“The purpose of this specific study was to determine the failure rate after anatomic single- and double-bundle ACL reconstruction with allograft and to identify factors associated with failure,” Van Eck said.
A prospective cohort study
The investigators performed a prospective cohort study involving 206 patients who underwent a total of 38 single- and 168 double-bundle ACL reconstructions with allograft between Jan. 2007 and Dec. 2009. Eighty percent of patients had at least 9 months follow-up. The patients had an average age of 24 years and an average body mass index of 24.5. The average return to competition after reconstruction was 263 days.
For the study, the authors defined failure as a subjective episode of instability, clinical examination revealing abnormal laxity, and/or an MRI or arthroscopic diagnosis of rupture or the absence of the ACL graft.
Overall, 13% of patients had graft failure. On average, patients in the double-bundle group who had a failure were younger (19 years vs. 25 years old) and had returned to competition earlier (222 days vs. 267 days). Four patients (11%) in the single-bundle group failed, Van Eck added. These patients were younger (19 years vs. 24 years old) and heavier (83 kg vs. 65 kg).
Longer to heal
“When we looked at our time to failure, we noticed that 48% of the subjects who failed did so before the 9-month mark, when we cleared them to return to sports, and an additional 44% in the first 9 months after returning to sports,” Van Eck said.
Van Eck noted that modifications in postoperative rehabilitation may be necessary in conjunction with modifications in return-to-sport protocol when dealing with patients who have had an anatomic ACL reconstruction.
“The relatively high observed failure rate in our study might be due to the exclusive use of allograft,” she concluded. “Allograft-reconstructed ACL may take longer to heal than when autograft is used. This means that we may need to evaluate graft healing — for example, using MRI — or we may need to enhance healing using tools such as fibrin clot or [platelet-rich plasma].”
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