Physiologic Preoperative Knee Hyperextension Is a Predictor of Failure in an Anterior Cruciate Ligament Revision Cohort: A Report From the MARS Group

The MARS Group

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Abstract

Background: The occurrence of physiologic knee hyperextension (HE) in the revision anterior cruciate ligament reconstruction (ACLR) population and its effect on outcomes have yet to be reported. Hypothesis/Purpose: The prevalence of knee HE in revision ACLR and its effect on 2-year outcome were studied with the hypothesis that preoperative physiologic knee HE ≥5° is a risk factor for anterior cruciate ligament (ACL) graft rupture. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing revision ACLR were identified and prospectively enrolled between 2006 and 2011. Study inclusion criteria were patients undergoing single-bundle graft reconstructions. Patients were followed up at 2 years and asked to complete an identical set of outcome instruments (International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, WOMAC, and Marx Activity Rating Scale) as well as provide information regarding revision ACL graft failure. A regression model with graft failure as the dependent variable included age, sex, graft type at the time of the revision ACL surgery, and physiologic preoperative passive HE ≥5° (yes/no) to assess these as potential risk factors for clinical outcomes 2 years after revision ACLR. Results: Analyses included 1145 patients, for whom 2-year follow-up was attained for 91%. The median age was 26 years, with age being a continuous variable. Those below the median were grouped as “younger” and those above as “older” (age: interquartile range = 20, 35 years), and 42% of patients were female. There were 50% autografts, 48% allografts, and 2% that had a combination of autograft plus allograft. Passive knee HE ≥5° was present in 374 (33%) patients in the revision cohort, with 52% being female. Graft rupture at 2-year follow-up occurred in 34 cases in the entire cohort, of which 12 were in the HE ≥5° group (3.2% failure rate) and 22 in the non-HE group (2.9% failure rate). The median age of patients who failed was 19 years, as opposed to 26 years for those with intact grafts. Three variables in the regression model were significant predictors of graft failure: younger age (odds ratio [OR] = 3.6; 95% CI, 1.6-7.9; P =.002), use of allograft (OR = 3.3; 95% CI, 1.5-7.4; P =.003), and HE ≥5° (OR = 2.12; 95% CI, 1.1-4.7; P =.03). Conclusion: This study revealed that preoperative physiologic passive knee HE ≥5° is present in one-third of patients who undergo revision ACLR. HE ≥5° was an independent significant predictor of graft failure after revision ACLR with a >2-fold OR of subsequent graft rupture in revision ACL surgery. Registration: NCT00625885 (ClinicalTrials.gov identifier).

Original languageEnglish (US)
Pages (from-to)2836-2841
Number of pages6
JournalAmerican Journal of Sports Medicine
Volume46
Issue number12
DOIs
StatePublished - Oct 1 2018
Externally publishedYes

Fingerprint

Anterior Cruciate Ligament
Knee
Anterior Cruciate Ligament Reconstruction
Transplants
Odds Ratio
Allografts
Rupture
Autografts
Knee Injuries
Knee Osteoarthritis
Documentation
Cohort Studies

Keywords

  • anterior cruciate ligament
  • graft failure
  • graft tensioning
  • knee hyperextension

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

@article{1b3116bed520448fbdb2c3c598d43c71,
title = "Physiologic Preoperative Knee Hyperextension Is a Predictor of Failure in an Anterior Cruciate Ligament Revision Cohort: A Report From the MARS Group",
abstract = "Background: The occurrence of physiologic knee hyperextension (HE) in the revision anterior cruciate ligament reconstruction (ACLR) population and its effect on outcomes have yet to be reported. Hypothesis/Purpose: The prevalence of knee HE in revision ACLR and its effect on 2-year outcome were studied with the hypothesis that preoperative physiologic knee HE ≥5° is a risk factor for anterior cruciate ligament (ACL) graft rupture. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing revision ACLR were identified and prospectively enrolled between 2006 and 2011. Study inclusion criteria were patients undergoing single-bundle graft reconstructions. Patients were followed up at 2 years and asked to complete an identical set of outcome instruments (International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, WOMAC, and Marx Activity Rating Scale) as well as provide information regarding revision ACL graft failure. A regression model with graft failure as the dependent variable included age, sex, graft type at the time of the revision ACL surgery, and physiologic preoperative passive HE ≥5° (yes/no) to assess these as potential risk factors for clinical outcomes 2 years after revision ACLR. Results: Analyses included 1145 patients, for whom 2-year follow-up was attained for 91{\%}. The median age was 26 years, with age being a continuous variable. Those below the median were grouped as “younger” and those above as “older” (age: interquartile range = 20, 35 years), and 42{\%} of patients were female. There were 50{\%} autografts, 48{\%} allografts, and 2{\%} that had a combination of autograft plus allograft. Passive knee HE ≥5° was present in 374 (33{\%}) patients in the revision cohort, with 52{\%} being female. Graft rupture at 2-year follow-up occurred in 34 cases in the entire cohort, of which 12 were in the HE ≥5° group (3.2{\%} failure rate) and 22 in the non-HE group (2.9{\%} failure rate). The median age of patients who failed was 19 years, as opposed to 26 years for those with intact grafts. Three variables in the regression model were significant predictors of graft failure: younger age (odds ratio [OR] = 3.6; 95{\%} CI, 1.6-7.9; P =.002), use of allograft (OR = 3.3; 95{\%} CI, 1.5-7.4; P =.003), and HE ≥5° (OR = 2.12; 95{\%} CI, 1.1-4.7; P =.03). Conclusion: This study revealed that preoperative physiologic passive knee HE ≥5° is present in one-third of patients who undergo revision ACLR. HE ≥5° was an independent significant predictor of graft failure after revision ACLR with a >2-fold OR of subsequent graft rupture in revision ACL surgery. Registration: NCT00625885 (ClinicalTrials.gov identifier).",
keywords = "anterior cruciate ligament, graft failure, graft tensioning, knee hyperextension",
author = "{The MARS Group} and Cooper, {Daniel E.} and Dunn, {Warren R.} and Huston, {Laura J.} and Haas, {Amanda K.} and Spindler, {Kurt P.} and Allen, {Christina R.} and Anderson, {Allen F.} and DeBerardino, {Thomas M.} and Lantz, {Brett (Brick) A.} and Barton Mann and Stuart, {Michael J.} and Albright, {John P.} and Amendola, {Annunziato (Ned)} and Andrish, {Jack T.} and Annunziata, {Christopher C.} and Arciero, {Robert A.} and Bach, {Bernard R.} and Baker, {Champ L.} and Bartolozzi, {Arthur R.} and Baumgarten, {Keith M.} and Bechler, {Jeffery R.} and Berg, {Jeffrey H.} and Bernas, {Geoffrey A.} and Brockmeier, {Stephen F.} and Brophy, {Robert H.} and Bush-Joseph, {Charles A.} and {Butler V}, {J. Brad} and Campbell, {John D.} and Carey, {James L.} and Carpenter, {James E.} and Cole, {Brian J.} and Cooper, {Jonathan M.} and Cox, {Charles L.} and Creighton, {R. Alexander} and Dahm, {Diane L.} and David, {Tal S.} and Flanigan, {David C.} and Frederick, {Robert W.} and Ganley, {Theodore J.} and Garofoli, {Elizabeth A.} and Gatt, {Charles J.} and Gecha, {Steven R.} and Giffin, {James Robert} and Hame, {Sharon L.} and Hannafin, {Jo A.} and Harner, {Christopher D.} and Harris, {Norman Lindsay} and Hechtman, {Keith S.} and Hershman, {Elliott B.} and Levy, {Bruce A}",
year = "2018",
month = "10",
day = "1",
doi = "10.1177/0363546518777732",
language = "English (US)",
volume = "46",
pages = "2836--2841",
journal = "American Journal of Sports Medicine",
issn = "0363-5465",
publisher = "SAGE Publications Inc.",
number = "12",

}

TY - JOUR

T1 - Physiologic Preoperative Knee Hyperextension Is a Predictor of Failure in an Anterior Cruciate Ligament Revision Cohort

T2 - A Report From the MARS Group

AU - The MARS Group

AU - Cooper, Daniel E.

AU - Dunn, Warren R.

AU - Huston, Laura J.

AU - Haas, Amanda K.

AU - Spindler, Kurt P.

AU - Allen, Christina R.

AU - Anderson, Allen F.

AU - DeBerardino, Thomas M.

AU - Lantz, Brett (Brick) A.

AU - Mann, Barton

AU - Stuart, Michael J.

AU - Albright, John P.

AU - Amendola, Annunziato (Ned)

AU - Andrish, Jack T.

AU - Annunziata, Christopher C.

AU - Arciero, Robert A.

AU - Bach, Bernard R.

AU - Baker, Champ L.

AU - Bartolozzi, Arthur R.

AU - Baumgarten, Keith M.

AU - Bechler, Jeffery R.

AU - Berg, Jeffrey H.

AU - Bernas, Geoffrey A.

AU - Brockmeier, Stephen F.

AU - Brophy, Robert H.

AU - Bush-Joseph, Charles A.

AU - Butler V, J. Brad

AU - Campbell, John D.

AU - Carey, James L.

AU - Carpenter, James E.

AU - Cole, Brian J.

AU - Cooper, Jonathan M.

AU - Cox, Charles L.

AU - Creighton, R. Alexander

AU - Dahm, Diane L.

AU - David, Tal S.

AU - Flanigan, David C.

AU - Frederick, Robert W.

AU - Ganley, Theodore J.

AU - Garofoli, Elizabeth A.

AU - Gatt, Charles J.

AU - Gecha, Steven R.

AU - Giffin, James Robert

AU - Hame, Sharon L.

AU - Hannafin, Jo A.

AU - Harner, Christopher D.

AU - Harris, Norman Lindsay

AU - Hechtman, Keith S.

AU - Hershman, Elliott B.

AU - Levy, Bruce A

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background: The occurrence of physiologic knee hyperextension (HE) in the revision anterior cruciate ligament reconstruction (ACLR) population and its effect on outcomes have yet to be reported. Hypothesis/Purpose: The prevalence of knee HE in revision ACLR and its effect on 2-year outcome were studied with the hypothesis that preoperative physiologic knee HE ≥5° is a risk factor for anterior cruciate ligament (ACL) graft rupture. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing revision ACLR were identified and prospectively enrolled between 2006 and 2011. Study inclusion criteria were patients undergoing single-bundle graft reconstructions. Patients were followed up at 2 years and asked to complete an identical set of outcome instruments (International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, WOMAC, and Marx Activity Rating Scale) as well as provide information regarding revision ACL graft failure. A regression model with graft failure as the dependent variable included age, sex, graft type at the time of the revision ACL surgery, and physiologic preoperative passive HE ≥5° (yes/no) to assess these as potential risk factors for clinical outcomes 2 years after revision ACLR. Results: Analyses included 1145 patients, for whom 2-year follow-up was attained for 91%. The median age was 26 years, with age being a continuous variable. Those below the median were grouped as “younger” and those above as “older” (age: interquartile range = 20, 35 years), and 42% of patients were female. There were 50% autografts, 48% allografts, and 2% that had a combination of autograft plus allograft. Passive knee HE ≥5° was present in 374 (33%) patients in the revision cohort, with 52% being female. Graft rupture at 2-year follow-up occurred in 34 cases in the entire cohort, of which 12 were in the HE ≥5° group (3.2% failure rate) and 22 in the non-HE group (2.9% failure rate). The median age of patients who failed was 19 years, as opposed to 26 years for those with intact grafts. Three variables in the regression model were significant predictors of graft failure: younger age (odds ratio [OR] = 3.6; 95% CI, 1.6-7.9; P =.002), use of allograft (OR = 3.3; 95% CI, 1.5-7.4; P =.003), and HE ≥5° (OR = 2.12; 95% CI, 1.1-4.7; P =.03). Conclusion: This study revealed that preoperative physiologic passive knee HE ≥5° is present in one-third of patients who undergo revision ACLR. HE ≥5° was an independent significant predictor of graft failure after revision ACLR with a >2-fold OR of subsequent graft rupture in revision ACL surgery. Registration: NCT00625885 (ClinicalTrials.gov identifier).

AB - Background: The occurrence of physiologic knee hyperextension (HE) in the revision anterior cruciate ligament reconstruction (ACLR) population and its effect on outcomes have yet to be reported. Hypothesis/Purpose: The prevalence of knee HE in revision ACLR and its effect on 2-year outcome were studied with the hypothesis that preoperative physiologic knee HE ≥5° is a risk factor for anterior cruciate ligament (ACL) graft rupture. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing revision ACLR were identified and prospectively enrolled between 2006 and 2011. Study inclusion criteria were patients undergoing single-bundle graft reconstructions. Patients were followed up at 2 years and asked to complete an identical set of outcome instruments (International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, WOMAC, and Marx Activity Rating Scale) as well as provide information regarding revision ACL graft failure. A regression model with graft failure as the dependent variable included age, sex, graft type at the time of the revision ACL surgery, and physiologic preoperative passive HE ≥5° (yes/no) to assess these as potential risk factors for clinical outcomes 2 years after revision ACLR. Results: Analyses included 1145 patients, for whom 2-year follow-up was attained for 91%. The median age was 26 years, with age being a continuous variable. Those below the median were grouped as “younger” and those above as “older” (age: interquartile range = 20, 35 years), and 42% of patients were female. There were 50% autografts, 48% allografts, and 2% that had a combination of autograft plus allograft. Passive knee HE ≥5° was present in 374 (33%) patients in the revision cohort, with 52% being female. Graft rupture at 2-year follow-up occurred in 34 cases in the entire cohort, of which 12 were in the HE ≥5° group (3.2% failure rate) and 22 in the non-HE group (2.9% failure rate). The median age of patients who failed was 19 years, as opposed to 26 years for those with intact grafts. Three variables in the regression model were significant predictors of graft failure: younger age (odds ratio [OR] = 3.6; 95% CI, 1.6-7.9; P =.002), use of allograft (OR = 3.3; 95% CI, 1.5-7.4; P =.003), and HE ≥5° (OR = 2.12; 95% CI, 1.1-4.7; P =.03). Conclusion: This study revealed that preoperative physiologic passive knee HE ≥5° is present in one-third of patients who undergo revision ACLR. HE ≥5° was an independent significant predictor of graft failure after revision ACLR with a >2-fold OR of subsequent graft rupture in revision ACL surgery. Registration: NCT00625885 (ClinicalTrials.gov identifier).

KW - anterior cruciate ligament

KW - graft failure

KW - graft tensioning

KW - knee hyperextension

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U2 - 10.1177/0363546518777732

DO - 10.1177/0363546518777732

M3 - Article

C2 - 29882693

AN - SCOPUS:85048266485

VL - 46

SP - 2836

EP - 2841

JO - American Journal of Sports Medicine

JF - American Journal of Sports Medicine

SN - 0363-5465

IS - 12

ER -