TY - JOUR
T1 - Incidence of second anterior cruciate ligament tears and identification of associated risk factors from 2001 to 2010 using a geographic database
AU - Schilaty, Nathan D.
AU - Nagelli, Christopher
AU - Bates, Nathaniel A.
AU - Sanders, Thomas L.
AU - Krych, Aaron J.
AU - Stuart, Michael J.
AU - Hewett, Timothy E.
N1 - Funding Information:
*Address correspondence to Nathan D. Schilaty, DC, PhD, Biomechanics Laboratory and Sports Medicine Center, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA (email: schilaty.nathan@mayo.edu). †Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA. ‡Biomechanics Laboratory and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA. §Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA. ||Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA. {Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA. One or more of the authors has declared the following potential conflict of interest or source of funding: Funding for this research was received from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR056259 [T.E.H.] and K12HD065987 and L30AR070273 [N.D.S.]). This study was also made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under award No. R01AG034676. Ethical approval for this study was obtained from the Olmsted Medical Center Institutional Review Board (study No. 026-OMC-14) and the Mayo Clinic Institutional Review Board (application No. 14-005089).
Publisher Copyright:
© The Author(s) 2017.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Background: The reported rate of second anterior cruciate ligament (ACL) injuries (20%-30%), including graft failure and contralateral ACL tears, after ACL reconstruction (ACLR) or nonoperative therapy indicates that multiple factors may predispose patients to subsequent ACL injuries. Purpose: To determine the incidence of second ACL injuries in a population-based cohort over a 10-year observation period (2001-2010) and to identify factors that contribute to the risk of second injuries. Study Design: Descriptive epidemiological study. Methods: International Classification of Diseases, 9th Revision (ICD-9) codes relevant to the diagnosis of an ACL tear and the procedure code for ACLR were utilized to search the Rochester Epidemiology Project, a multidisciplinary county database, between the years of 2001 and 2010. The complete medical records for all cases were reviewed to confirm diagnosis and treatment details. A total of 914 unique patients with 1019 acute, isolated ACL tears were identified. These patients were stratified by primary and secondary tears, sex, age, activity level, side of injury, sex × side of injury, and graft type of reconstruction. Results: Second ACL tears were recorded in 141 (13.8%) of the 914 patients diagnosed with an ACL tear in Olmsted County, Minnesota, USA, from 2001 to 2010; 50.4% of these occurred in the contralateral knee. A noncontact mechanism was responsible for 76.4% of all ACL injuries. A second ACL injury was influenced by factors of sex × age group, treatment type × age group, and treatment type × activity level. Nonparametric analysis of graft disruption × graft type demonstrated that a higher prevalence of second ACL tears occurred with allografts compared with hamstring autografts (P = .0054) and patellar tendon autografts (P = .0001). Conclusion: The incidence of second ACL tears in this population-based cohort was 13.8%, and half occurred to the ACL of the contralateral knee. Statistically, second ACL injuries differed by sex, occurring in female patients younger than 25 years and male patients aged 26 to 45 years. Allografts continued to be associated with a greater risk of second ACL injuries compared with hamstring and patellar tendon autografts. Nonoperative treatment carried more risk of contralateral tears than ACLR.
AB - Background: The reported rate of second anterior cruciate ligament (ACL) injuries (20%-30%), including graft failure and contralateral ACL tears, after ACL reconstruction (ACLR) or nonoperative therapy indicates that multiple factors may predispose patients to subsequent ACL injuries. Purpose: To determine the incidence of second ACL injuries in a population-based cohort over a 10-year observation period (2001-2010) and to identify factors that contribute to the risk of second injuries. Study Design: Descriptive epidemiological study. Methods: International Classification of Diseases, 9th Revision (ICD-9) codes relevant to the diagnosis of an ACL tear and the procedure code for ACLR were utilized to search the Rochester Epidemiology Project, a multidisciplinary county database, between the years of 2001 and 2010. The complete medical records for all cases were reviewed to confirm diagnosis and treatment details. A total of 914 unique patients with 1019 acute, isolated ACL tears were identified. These patients were stratified by primary and secondary tears, sex, age, activity level, side of injury, sex × side of injury, and graft type of reconstruction. Results: Second ACL tears were recorded in 141 (13.8%) of the 914 patients diagnosed with an ACL tear in Olmsted County, Minnesota, USA, from 2001 to 2010; 50.4% of these occurred in the contralateral knee. A noncontact mechanism was responsible for 76.4% of all ACL injuries. A second ACL injury was influenced by factors of sex × age group, treatment type × age group, and treatment type × activity level. Nonparametric analysis of graft disruption × graft type demonstrated that a higher prevalence of second ACL tears occurred with allografts compared with hamstring autografts (P = .0054) and patellar tendon autografts (P = .0001). Conclusion: The incidence of second ACL tears in this population-based cohort was 13.8%, and half occurred to the ACL of the contralateral knee. Statistically, second ACL injuries differed by sex, occurring in female patients younger than 25 years and male patients aged 26 to 45 years. Allografts continued to be associated with a greater risk of second ACL injuries compared with hamstring and patellar tendon autografts. Nonoperative treatment carried more risk of contralateral tears than ACLR.
KW - Anterior cruciate ligament (ACL)
KW - Epidemiology
KW - Graft tear
KW - Incidence
KW - Secondary
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U2 - 10.1177/2325967117724196
DO - 10.1177/2325967117724196
M3 - Article
AN - SCOPUS:85028584126
VL - 5
JO - Orthopaedic Journal of Sports Medicine
JF - Orthopaedic Journal of Sports Medicine
SN - 2325-9671
IS - 8
M1 - 2325967117724196
ER -