Predictive factors for failure of anterior cruciate ligament reconstruction via the trans-tibial technique
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ARTHROSCOPY AND SPORTS MEDICINE
Predictive factors for failure of anterior cruciate ligament reconstruction via the trans‑tibial technique Seong Hwan Kim1 · Yong‑Beom Park2 · Dong‑Hyun Kim2 · Nicolas Pujol3 · Han‑Jun Lee2 Received: 14 November 2019 / Accepted: 14 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Factors for graft failure after trans-tibial (TT) ACL reconstruction, including anterolateral ligament (ALL) injury and degree of synovialization, remain unclear. This study is to evaluate the risk factors for graft failures after TT ACL reconstruction including ALL injury and synovialization. Materials and methods A total 391 patients who underwent primary TT ACL reconstruction were included. Failure was defined as greater than grade 2 laxity on the Lachman or pivot shift tests or 5 mm of anterior translation on stress radiograph. After applying inclusion/exclusion criteria, 31 patients with failure were categorized as group 1 and 89 patients without failure were categorized as group 2. Chi-square test and Cox proportional hazard analyses were performed. Results Preoperatively, 64 patients had ALL injuries (53.3%), 58 had medial meniscal (MM) tears (48.3%), and 62 had lateral meniscal (LM) tears (51.6%). Ninety-three patients (77.5%) had acute injuries and 27 had chronic injuries as per 6-weeks duration. Significant risk factors for failure were LM tear (hazard ratio [HR], 4.018; 95% confidence interval [CI] 1.677–9.629; p = 0.002), chronicity (HR, 6.812; 95% CI 2.758–16.824; p = 0.000), presence of ALL injury (HR, 3.655; 95% CI 1.442–9.265; p = 0.006), and poor synovialization (HR, 3.134; 95% CI 1.298–7.566; p = 0.011) in Cox proportional hazard analysis. If combined MM and LM tears were found, an increased risk of failure was also identified (combined tears: HR, 3.951; 95% CI 1.754–8.901; p = 0.001/preoperative high-grade laxity: HR, 4.546; 95% CI 1.875–11.02; p = 0.001). Conclusion Chronic ACL injuries, meniscus tear, preoperative ALL injuries, preoperative high-grade laxity and poor synovialization are significant risk factors. Therefore, these factors should be carefully assessed and properly treated in TT ACL reconstruction. Level of evidence IV, retrospective cohort study. Keywords Anterior cruciate ligament · Reconstruction · Trans-tibial technique · Failure · Risk factor
Introduction
Seong Hwan Kim and Yong-Beom Park contributed equally to this study. * Han‑Jun Lee [email protected] 1
Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Namyangju‑Si, Kyunggi‑Do, South Korea
2
Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok‑ro, Dongjak‑gu, Seoul 06973, South Korea
3
Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
Anterior cruciate ligament (ACL) reconstruction is the most frequently performed knee ligament surgery [1, 2]. It is highly successful for restoring stability, decreasing long-term degenerative
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