Increased age and modified fragility index increases risk of short-term complications after anterior cruciate ligament reconstruction surgery

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

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.

Characteristics of early complications in isolated primary anterior cruciate ligament reconstruction surgery

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.