Subsequent Surgery after Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors from a Multicenter Cohort

David Y. Ding, Alan L. Zhang, Christina R. Allen, Allen F. Anderson, Daniel E. Cooper, Thomas M. Deberardino, Warren R. Dunn, Amanda K. Haas, Laura J. Huston, A. Lantz, Barton Mann, Kurt P. Spindler, Michael J. Stuart, Rick W. Wright, John P. Albright, Annunziato Amendola, Jack T. Andrish, Christopher C. Annunziata, Robert A. Arciero, Bernard R. BachChamp L. Baker, Arthur R. Bartolozzi, Keith M. Baumgarten, Jeffery R. Bechler, Jeffrey H. Berg, Geoffrey A. Bernas, Stephen F. Brockmeier, Robert H. Brophy, Charles A. Bush-Joseph, J. Brad Butler, John D. Campbell, James L. Carey, James E. Carpenter, Brian J. Cole, Jonathan M. Cooper, Charles L. Cox, R. Alexander Creighton, Diane L. Dahm, Tal S. David, David C. Flanigan, Robert W. Frederick, Theodore J. Ganley, Elizabeth A. Garofoli, Charles J. Gatt, Steven R. Gecha, James Robert Giffin, Sharon L. Hame, Jo A. Hannafin, Christopher D. Harner, Bruce A. Levy

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: While revision anterior cruciate ligament reconstruction (ACLR) can be performed to restore knee stability and improve patient activity levels, outcomes after this surgery are reported to be inferior to those after primary ACLR. Further reoperations after revision ACLR can have an even more profound effect on patient satisfaction and outcomes. However, there is a current lack of information regarding the rate and risk factors for subsequent surgery after revision ACLR. Purpose: To report the rate of reoperations, procedures performed, and risk factors for a reoperation 2 years after revision ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 1205 patients who underwent revision ACLR were enrolled in the Multicenter ACL Revision Study (MARS) between 2006 and 2011, composing the prospective cohort. Two-year questionnaire follow-up was obtained for 989 patients (82%), while telephone follow-up was obtained for 1112 patients (92%). If a patient reported having undergone subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Multivariate regression analysis was performed to determine independent risk factors for a reoperation. Results: Of the 1112 patients included in the analysis, 122 patients (11%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperations, 27% were meniscal procedures (69% meniscectomy, 26% repair), 19% were subsequent revision ACLR, 17% were cartilage procedures (61% chondroplasty, 17% microfracture, 13% mosaicplasty), 11% were hardware removal, and 9% were procedures for arthrofibrosis. Multivariate analysis revealed that patients aged <20 years had twice the odds of patients aged 20 to 29 years to undergo a reoperation. The use of an allograft at the time of revision ACLR (odds ratio [OR], 1.79; P =.007) was a significant predictor for reoperations at 2 years, while staged revision (bone grafting of tunnels before revision ACLR) (OR, 1.93; P =.052) did not reach significance. Patients with grade 4 cartilage damage seen during revision ACLR were 78% less likely to undergo subsequent operations within 2 years. Sex, body mass index, smoking history, Marx activity score, technique for femoral tunnel placement, and meniscal tearing or meniscal treatment at the time of revision ACLR showed no significant effect on the reoperation rate. Conclusion: There was a significant reoperation rate after revision ACLR at 2 years (11%), with meniscal procedures most commonly involved. Independent risk factors for subsequent surgery on the ipsilateral knee included age <20 years and the use of allograft tissue at the time of revision ACLR.

Original languageEnglish (US)
Pages (from-to)2068-2076
Number of pages9
JournalAmerican Journal of Sports Medicine
Volume45
Issue number9
DOIs
StatePublished - Jul 1 2017

Fingerprint

Anterior Cruciate Ligament Reconstruction
Reoperation
Knee
Cartilage
Allografts
Multivariate Analysis
Odds Ratio
Stress Fractures
Bone Transplantation
Thigh
Patient Satisfaction
Telephone
Case-Control Studies
Body Mass Index

Keywords

  • outcomes
  • reoperation
  • revision anterior cruciate ligament reconstruction
  • risk factors
  • subsequent surgery

ASJC Scopus subject areas

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

Cite this

Subsequent Surgery after Revision Anterior Cruciate Ligament Reconstruction : Rates and Risk Factors from a Multicenter Cohort. / Ding, David Y.; Zhang, Alan L.; Allen, Christina R.; Anderson, Allen F.; Cooper, Daniel E.; Deberardino, Thomas M.; Dunn, Warren R.; Haas, Amanda K.; Huston, Laura J.; Lantz, A.; Mann, Barton; Spindler, Kurt P.; Stuart, Michael J.; Wright, Rick W.; Albright, John P.; Amendola, Annunziato; Andrish, Jack T.; Annunziata, Christopher C.; Arciero, Robert A.; Bach, Bernard R.; Baker, Champ L.; Bartolozzi, Arthur R.; Baumgarten, Keith M.; Bechler, Jeffery R.; Berg, Jeffrey H.; Bernas, Geoffrey A.; Brockmeier, Stephen F.; Brophy, Robert H.; Bush-Joseph, Charles A.; Butler, J. Brad; Campbell, John D.; Carey, James L.; Carpenter, James E.; Cole, Brian J.; Cooper, Jonathan M.; Cox, Charles L.; Creighton, R. Alexander; Dahm, Diane L.; David, Tal S.; Flanigan, David C.; Frederick, Robert W.; Ganley, Theodore J.; Garofoli, Elizabeth A.; Gatt, Charles J.; Gecha, Steven R.; Giffin, James Robert; Hame, Sharon L.; Hannafin, Jo A.; Harner, Christopher D.; Levy, Bruce A.

In: American Journal of Sports Medicine, Vol. 45, No. 9, 01.07.2017, p. 2068-2076.

Research output: Contribution to journalArticle

Ding, DY, Zhang, AL, Allen, CR, Anderson, AF, Cooper, DE, Deberardino, TM, Dunn, WR, Haas, AK, Huston, LJ, Lantz, A, Mann, B, Spindler, KP, Stuart, MJ, Wright, RW, Albright, JP, Amendola, A, Andrish, JT, Annunziata, CC, Arciero, RA, Bach, BR, Baker, CL, Bartolozzi, AR, Baumgarten, KM, Bechler, JR, Berg, JH, Bernas, GA, Brockmeier, SF, Brophy, RH, Bush-Joseph, CA, Butler, JB, Campbell, JD, Carey, JL, Carpenter, JE, Cole, BJ, Cooper, JM, Cox, CL, Creighton, RA, Dahm, DL, David, TS, Flanigan, DC, Frederick, RW, Ganley, TJ, Garofoli, EA, Gatt, CJ, Gecha, SR, Giffin, JR, Hame, SL, Hannafin, JA, Harner, CD & Levy, BA 2017, 'Subsequent Surgery after Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors from a Multicenter Cohort', American Journal of Sports Medicine, vol. 45, no. 9, pp. 2068-2076. https://doi.org/10.1177/0363546517707207
Ding, David Y. ; Zhang, Alan L. ; Allen, Christina R. ; Anderson, Allen F. ; Cooper, Daniel E. ; Deberardino, Thomas M. ; Dunn, Warren R. ; Haas, Amanda K. ; Huston, Laura J. ; Lantz, A. ; Mann, Barton ; Spindler, Kurt P. ; Stuart, Michael J. ; Wright, Rick W. ; Albright, John P. ; Amendola, Annunziato ; Andrish, Jack T. ; Annunziata, Christopher C. ; Arciero, Robert A. ; Bach, Bernard R. ; Baker, Champ L. ; Bartolozzi, Arthur R. ; Baumgarten, Keith M. ; Bechler, Jeffery R. ; Berg, Jeffrey H. ; Bernas, Geoffrey A. ; Brockmeier, Stephen F. ; Brophy, Robert H. ; Bush-Joseph, Charles A. ; Butler, J. Brad ; Campbell, John D. ; Carey, James L. ; Carpenter, James E. ; Cole, Brian J. ; Cooper, Jonathan M. ; Cox, Charles L. ; Creighton, R. Alexander ; Dahm, Diane L. ; David, Tal S. ; Flanigan, David C. ; Frederick, Robert W. ; Ganley, Theodore J. ; Garofoli, Elizabeth A. ; Gatt, Charles J. ; Gecha, Steven R. ; Giffin, James Robert ; Hame, Sharon L. ; Hannafin, Jo A. ; Harner, Christopher D. ; Levy, Bruce A. / Subsequent Surgery after Revision Anterior Cruciate Ligament Reconstruction : Rates and Risk Factors from a Multicenter Cohort. In: American Journal of Sports Medicine. 2017 ; Vol. 45, No. 9. pp. 2068-2076.
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title = "Subsequent Surgery after Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors from a Multicenter Cohort",
abstract = "Background: While revision anterior cruciate ligament reconstruction (ACLR) can be performed to restore knee stability and improve patient activity levels, outcomes after this surgery are reported to be inferior to those after primary ACLR. Further reoperations after revision ACLR can have an even more profound effect on patient satisfaction and outcomes. However, there is a current lack of information regarding the rate and risk factors for subsequent surgery after revision ACLR. Purpose: To report the rate of reoperations, procedures performed, and risk factors for a reoperation 2 years after revision ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 1205 patients who underwent revision ACLR were enrolled in the Multicenter ACL Revision Study (MARS) between 2006 and 2011, composing the prospective cohort. Two-year questionnaire follow-up was obtained for 989 patients (82{\%}), while telephone follow-up was obtained for 1112 patients (92{\%}). If a patient reported having undergone subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Multivariate regression analysis was performed to determine independent risk factors for a reoperation. Results: Of the 1112 patients included in the analysis, 122 patients (11{\%}) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperations, 27{\%} were meniscal procedures (69{\%} meniscectomy, 26{\%} repair), 19{\%} were subsequent revision ACLR, 17{\%} were cartilage procedures (61{\%} chondroplasty, 17{\%} microfracture, 13{\%} mosaicplasty), 11{\%} were hardware removal, and 9{\%} were procedures for arthrofibrosis. Multivariate analysis revealed that patients aged <20 years had twice the odds of patients aged 20 to 29 years to undergo a reoperation. The use of an allograft at the time of revision ACLR (odds ratio [OR], 1.79; P =.007) was a significant predictor for reoperations at 2 years, while staged revision (bone grafting of tunnels before revision ACLR) (OR, 1.93; P =.052) did not reach significance. Patients with grade 4 cartilage damage seen during revision ACLR were 78{\%} less likely to undergo subsequent operations within 2 years. Sex, body mass index, smoking history, Marx activity score, technique for femoral tunnel placement, and meniscal tearing or meniscal treatment at the time of revision ACLR showed no significant effect on the reoperation rate. Conclusion: There was a significant reoperation rate after revision ACLR at 2 years (11{\%}), with meniscal procedures most commonly involved. Independent risk factors for subsequent surgery on the ipsilateral knee included age <20 years and the use of allograft tissue at the time of revision ACLR.",
keywords = "outcomes, reoperation, revision anterior cruciate ligament reconstruction, risk factors, subsequent surgery",
author = "Ding, {David Y.} and Zhang, {Alan L.} and Allen, {Christina R.} and Anderson, {Allen F.} and Cooper, {Daniel E.} and Deberardino, {Thomas M.} and Dunn, {Warren R.} and Haas, {Amanda K.} and Huston, {Laura J.} and A. Lantz and Barton Mann and Spindler, {Kurt P.} and Stuart, {Michael J.} and Wright, {Rick W.} and Albright, {John P.} and Annunziato Amendola 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, {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 Levy, {Bruce A.}",
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TY - JOUR

T1 - Subsequent Surgery after Revision Anterior Cruciate Ligament Reconstruction

T2 - Rates and Risk Factors from a Multicenter Cohort

AU - Ding, David Y.

AU - Zhang, Alan L.

AU - Allen, Christina R.

AU - Anderson, Allen F.

AU - Cooper, Daniel E.

AU - Deberardino, Thomas M.

AU - Dunn, Warren R.

AU - Haas, Amanda K.

AU - Huston, Laura J.

AU - Lantz, A.

AU - Mann, Barton

AU - Spindler, Kurt P.

AU - Stuart, Michael J.

AU - Wright, Rick W.

AU - Albright, John P.

AU - Amendola, Annunziato

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, 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 - Levy, Bruce A.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background: While revision anterior cruciate ligament reconstruction (ACLR) can be performed to restore knee stability and improve patient activity levels, outcomes after this surgery are reported to be inferior to those after primary ACLR. Further reoperations after revision ACLR can have an even more profound effect on patient satisfaction and outcomes. However, there is a current lack of information regarding the rate and risk factors for subsequent surgery after revision ACLR. Purpose: To report the rate of reoperations, procedures performed, and risk factors for a reoperation 2 years after revision ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 1205 patients who underwent revision ACLR were enrolled in the Multicenter ACL Revision Study (MARS) between 2006 and 2011, composing the prospective cohort. Two-year questionnaire follow-up was obtained for 989 patients (82%), while telephone follow-up was obtained for 1112 patients (92%). If a patient reported having undergone subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Multivariate regression analysis was performed to determine independent risk factors for a reoperation. Results: Of the 1112 patients included in the analysis, 122 patients (11%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperations, 27% were meniscal procedures (69% meniscectomy, 26% repair), 19% were subsequent revision ACLR, 17% were cartilage procedures (61% chondroplasty, 17% microfracture, 13% mosaicplasty), 11% were hardware removal, and 9% were procedures for arthrofibrosis. Multivariate analysis revealed that patients aged <20 years had twice the odds of patients aged 20 to 29 years to undergo a reoperation. The use of an allograft at the time of revision ACLR (odds ratio [OR], 1.79; P =.007) was a significant predictor for reoperations at 2 years, while staged revision (bone grafting of tunnels before revision ACLR) (OR, 1.93; P =.052) did not reach significance. Patients with grade 4 cartilage damage seen during revision ACLR were 78% less likely to undergo subsequent operations within 2 years. Sex, body mass index, smoking history, Marx activity score, technique for femoral tunnel placement, and meniscal tearing or meniscal treatment at the time of revision ACLR showed no significant effect on the reoperation rate. Conclusion: There was a significant reoperation rate after revision ACLR at 2 years (11%), with meniscal procedures most commonly involved. Independent risk factors for subsequent surgery on the ipsilateral knee included age <20 years and the use of allograft tissue at the time of revision ACLR.

AB - Background: While revision anterior cruciate ligament reconstruction (ACLR) can be performed to restore knee stability and improve patient activity levels, outcomes after this surgery are reported to be inferior to those after primary ACLR. Further reoperations after revision ACLR can have an even more profound effect on patient satisfaction and outcomes. However, there is a current lack of information regarding the rate and risk factors for subsequent surgery after revision ACLR. Purpose: To report the rate of reoperations, procedures performed, and risk factors for a reoperation 2 years after revision ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 1205 patients who underwent revision ACLR were enrolled in the Multicenter ACL Revision Study (MARS) between 2006 and 2011, composing the prospective cohort. Two-year questionnaire follow-up was obtained for 989 patients (82%), while telephone follow-up was obtained for 1112 patients (92%). If a patient reported having undergone subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Multivariate regression analysis was performed to determine independent risk factors for a reoperation. Results: Of the 1112 patients included in the analysis, 122 patients (11%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperations, 27% were meniscal procedures (69% meniscectomy, 26% repair), 19% were subsequent revision ACLR, 17% were cartilage procedures (61% chondroplasty, 17% microfracture, 13% mosaicplasty), 11% were hardware removal, and 9% were procedures for arthrofibrosis. Multivariate analysis revealed that patients aged <20 years had twice the odds of patients aged 20 to 29 years to undergo a reoperation. The use of an allograft at the time of revision ACLR (odds ratio [OR], 1.79; P =.007) was a significant predictor for reoperations at 2 years, while staged revision (bone grafting of tunnels before revision ACLR) (OR, 1.93; P =.052) did not reach significance. Patients with grade 4 cartilage damage seen during revision ACLR were 78% less likely to undergo subsequent operations within 2 years. Sex, body mass index, smoking history, Marx activity score, technique for femoral tunnel placement, and meniscal tearing or meniscal treatment at the time of revision ACLR showed no significant effect on the reoperation rate. Conclusion: There was a significant reoperation rate after revision ACLR at 2 years (11%), with meniscal procedures most commonly involved. Independent risk factors for subsequent surgery on the ipsilateral knee included age <20 years and the use of allograft tissue at the time of revision ACLR.

KW - outcomes

KW - reoperation

KW - revision anterior cruciate ligament reconstruction

KW - risk factors

KW - subsequent surgery

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