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Helito CP, da Silva AGM, Cristiani R, Stålman A, de Pádua VBC, Gobbi RG, Pécora JR. Patients submitted to re-revision ACL reconstruction present more knee laxity, more complications, and a higher failure rate than patients submitted to the first revision ACL reconstruction. Knee 2025; 52:147-154. [PMID: 39577113 DOI: 10.1016/j.knee.2024.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 09/07/2024] [Accepted: 11/05/2024] [Indexed: 11/24/2024]
Abstract
BACKGROUND Few comparative studies have evaluated patients who underwent two revision anterior cruciate ligament reconstruction (ACLR) and patients who underwent one revision ACLR, and many of them have a short postoperative follow-up and a relatively small number of patients. The objective of this study is to evaluate the functional results, complications, and failure rates of patients who underwent one revision ACLR and patients who underwent two revision ACLRs. METHODS This is a retrospective study comparing patients who underwent one revision ACLR (Group 1) with patients who underwent a re-revision ACLR (Group 2). Baseline demographic variables, operative data and post-operative data were evaluated. RESULTS Among the 266 patients included, 226 were from Group 1 and 40 from Group 2. Patients in Group 2 had greater rotatory laxity and were more often subjected to associated osteotomy at the time of revision surgery. Postoperatively, patients from Group 2 reported poorer subjective IKDC score and showed greater knee laxity measured with the KT-1000 arthrometer, although both probably not clinically relevant. The complication rate was high in both groups, with a higher incidence in Group 2. Reconstruction failures were also higher in Group 2 (20% vs. 8.8%, p = 0.03). CONCLUSION Patients from Group 2 underwent a higher rate of associated osteotomy procedures, present higher complication rates and a higher failure rate compared with patients from Group 1. However, the functional scores (Lysholm and IKDC score) and the physical examination (KT-1000 and pivot-shift) did not show clinically relevant differences between the groups. LEVEL OF EVIDENCE III, retrospective comparative therapeutic trial.
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Affiliation(s)
- Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333 - Cerqueira Cesar, São Paulo, SP CEP: 05403-010, Brazil; Hospital Sírio Libanês, Rua Dona Adma Jafet, 91 - Bela Vista, São Paulo, SP CEP 01308-050, Brazil
| | - Andre Giardino Moreira da Silva
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333 - Cerqueira Cesar, São Paulo, SP CEP: 05403-010, Brazil.
| | - Riccardo Cristiani
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden, Solnavägen 1, 171 77 Solna, Stockholm, Sweden; Stockholm Sports Trauma Research Center, FIFA Medical Centre of Excellence, Stockholm, Sweden, Valhallavägen 91, 114 86, Stockholm, Sweden
| | - Anders Stålman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden, Solnavägen 1, 171 77 Solna, Stockholm, Sweden; Stockholm Sports Trauma Research Center, FIFA Medical Centre of Excellence, Stockholm, Sweden, Valhallavägen 91, 114 86, Stockholm, Sweden
| | - Vitor Barion Castro de Pádua
- Departamento de Ortopedia, Faculdade de Medicina da Universidade de Marilia, Avenida Hygino Muzzy Filho, 1001, Marilia, SP CEP 17525-902, Brazil
| | - Riccardo Gomes Gobbi
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333 - Cerqueira Cesar, São Paulo, SP CEP: 05403-010, Brazil; HCor Hospital do Coração, Rua Desembargador Eliseu Guilherme, 147 - Paraíso, São Paulo, SP CEP 04004-030, Brazil
| | - José Ricardo Pécora
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333 - Cerqueira Cesar, São Paulo, SP CEP: 05403-010, Brazil
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Zhong J, Lee NJ, Crutchfield C, Mueller J, Ahmad C, Trofa D, Lynch TS. Characteristics of early complications in isolated primary anterior cruciate ligament reconstruction surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2673-2682. [PMID: 38748272 DOI: 10.1007/s00590-024-03973-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/29/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE The early complications of isolated anterior cruciate ligament reconstruction surgery (ACLR) have not been well characterized using large databases. This study aims to characterize incidence, impact, and risk factors for short-term operative complications following elective, isolated ACLR surgery. We hypothesize that demographic and perioperative factors may predict 30-day complications after isolated ACLR. METHODS This case-control analysis of the American College of Surgeons National Surgical Quality Improvement Program Database (2005-2017) used Current Procedural Terminology codes to identify elective, isolated ACLR patients. Patients undergoing concomitant procedures were excluded. Complications were analyzed using bivariate analysis against demographic variables. Multiple stepwise logistic regression was used to identify independent risk factors for morbidity after ACLR. RESULTS A total 12,790 patients (37.0% female, p = 0.674) were included with a mean age of 32.2 years old (SD 10.7 years, p < 0.001). Mean BMI was 27.8 kg/m2 (6.5) where 28.9% of patients had a BMI > 30 (p = 0.064). The most common complications were wound-related (0.57%). In cases with complications, there were higher rates of (1.3% vs 0.8%, p = 0.004) prolonged operation (> 1.5 h), higher rate (2.9% vs 1.8%, p = 0.004) of extended length of stay (≥ 1 day), unplanned reoperation (15.8% vs 0.3%, p < 0.001), and unplanned readmission (17.5% vs 0.3%, p < 0.001). Multivariate analysis showed prolonged operative time (p = 0.001), dyspnea (p = 0.008), and non-ambulatory surgery (p = 0.034) to be predictive of any complication. Dependent functional status (p = 0.091), mFI-5 > 0.2 (= 0.173), female sex (p = 0.191), obesity (p = 0.101), and smoking (p = 0.113) were not risk factors for complications. CONCLUSION ACLR is associated with low rates of morbidity and readmissions. The most common comorbidities, complications, and predictors of morbidities were identified to aid surgeons in further reducing adverse outcomes of ACLR. Operative time > 1.5 h, dyspnea, and non-ambulatory surgery are predictive of complications.
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Affiliation(s)
- Jack Zhong
- Department of Orthopedic Surgery, Columbia University, Address: 301 East 17th Street, 14th floor, New York, NY, 10003, USA.
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, 10016, USA.
| | - Nathan J Lee
- Department of Orthopedic Surgery, Columbia University, Address: 301 East 17th Street, 14th floor, New York, NY, 10003, USA
| | - Connor Crutchfield
- Department of Orthopedic Surgery, Columbia University, Address: 301 East 17th Street, 14th floor, New York, NY, 10003, USA
| | - John Mueller
- Department of Orthopedic Surgery, Columbia University, Address: 301 East 17th Street, 14th floor, New York, NY, 10003, USA
| | - Christopher Ahmad
- Department of Orthopedic Surgery, Columbia University, Address: 301 East 17th Street, 14th floor, New York, NY, 10003, USA
| | - David Trofa
- Department of Orthopedic Surgery, Columbia University, Address: 301 East 17th Street, 14th floor, New York, NY, 10003, USA
| | - T S Lynch
- Department of Orthopedic Surgery, Columbia University, Address: 301 East 17th Street, 14th floor, New York, NY, 10003, USA
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, USA
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