Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction.
BACKGROUND
Graft rupture of the same knee or injury to the anterior cruciate ligament (ACL) in the contralateral knee is a devastating outcome after ACL reconstruction surgery. While a number of factors have been identified as potentially increasing the risk of subsequent ACL injury, the literature is far from definitive.


OBJECTIVE
To determine the rates of graft rupture and contralateral ACL injury in a large cohort and to investigate patient characteristics that may be associated with these.


METHODS
Case-control study; Level of evidence, 3.


METHODS
A consecutive cohort of 750 patients who had undergone primary ACL reconstruction surgery with a minimum 3-year follow-up were questioned about the incidence of ACL graft rupture, contralateral ACL injury, family history of ACL injury, and current activity level. Patient databases provided details for age, sex, original injury mechanism, meniscus or articular surface injury, and graft diameter.


RESULTS
Responses were received from 561 patients (75%) at a mean ± SD follow-up time of 4.8 ± 1.1 years. Anterior cruciate ligament graft ruptures occurred in 25 patients (4.5%), and contralateral ACL injuries occurred in 42 patients (7.5%). The highest incidence of further ACL injury occurred in patients younger than 20 years at the time of surgery. In this group, 29% sustained a subsequent ACL injury to either knee. The odds for sustaining an ACL graft rupture or contralateral injury increased 6- and 3-fold, respectively, for patients younger than 20 years. Returning to cutting/pivoting sports increased the odds of graft rupture by a factor of 3.9 and contralateral rupture by a factor of 5. A positive family history doubled the odds for both graft rupture and contralateral ACL injury.


CONCLUSIONS
Patients younger than 20 years who undergo ACL reconstruction are at significantly increased risk for both graft rupture and contralateral ACL injury. Whether age per se is a risk factor or age represents a proxy for other factors remains to be determined.
Kate E. Webster, School of Allied Health, Faculty of Health Sciences, La Trobe University, Victoria 3086, Australia. k.webster@latrobe.edu.au.
Kate E
KE
Webster
Julian A
JA
Feller
Warren B
WB
Leigh
Anneka K
AK
Richmond
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction; D001265:Athletic Injuries / Q000453:epidemiology; D064592:Autografts; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012307:Risk Factors; D012421:Rupture / Q000453:epidemiology / Q000209:etiology; D013708:Tendon Injuries / Q000453:epidemiology*; D013710:Tendons / Q000033:anatomy & histology / Q000637:transplantation*; D055815:Young Adult
ACL reconstruction; age; failure rate; graft survival; risk factors