Surgical Predictors of Early Revision Surgery After Anterior Cruciate Ligament Reconstruction: Results From the Swedish National Knee Ligament Register on 13,102 Patients.
BACKGROUND
An important objective of anterior cruciate ligament (ACL) registries is to detect and report early graft failure and revision surgery after ACL reconstruction.


OBJECTIVE
To investigate surgical variables and identify predictors of revision surgery after ACL reconstruction.


METHODS
Prospective cohort study; Level of evidence, 2.


METHODS
This prospective cohort study was based on data from the Swedish National Knee Ligament Register during the years 2005 through 2011. Eight surgical variables were investigated: graft selection, graft width, single-bundle or double-bundle techniques, femoral graft fixation, tibial graft fixation, injury-to-surgery interval, injuries to menisci, and injuries to cartilage. The primary endpoint was the 2-year incidence of revision surgery. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated and adjusted for confounders by use of multivariate statistics.


RESULTS
A total of 13,102 patients were included (5541 women [42%] and 7561 men [58%]; P < .001). Hamstring tendon autografts accounted for 90% (11,764 patients) of all reconstructions, of which 96% were performed with a single-bundle technique (11,339 patients). Patellar tendon autografts accounted for the remaining 10% (1338 patients). At index reconstruction, observed injuries to menisci and cartilage were common (40% and 28%, respectively). The overall 2-year incidence of revision surgery was 1.60% (women, 1.57%; men, 1.63%; P = .854). Patients with metal interference screw fixation of a semitendinosus tendon autograft on the tibia had a significantly reduced risk of early revision surgery (RR = 0.32; 95% CI, 0.12-0.90; P = .031).


CONCLUSIONS
Metal interference screw fixation of a semitendinosus tendon autograft on the tibia was an independent predictor of significantly lower 2-year incidence of revision surgery. Graft selection, graft width, a single-bundle or a double-bundle technique, femoral graft fixation, the injury-to-surgery interval, and meniscus injury were not predictors of early revision surgery.
Vårdcentralen Gripen, Karlstad, Sweden Primary Care Research Unit, Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden daniel.andernord@gmail.com.
Daniel
D
Andernord
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
Haukur
H
Björnsson
Akademistatistik-Centre for Applied Biostatistics, Occupational and Environmental Medicine, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
Max
M
Petzold
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
Bengt I
BI
Eriksson
Capio Artro Clinic AB, Stockholm, Sweden Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden.
Magnus
M
Forssblad
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
Jón
J
Karlsson
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
Kristian
K
Samuelsson
D000293:Adolescent; D000328:Adult; D000368:Aged; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001863:Bone Screws; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017847:Patellar Ligament / Q000601:surgery; D011446:Prospective Studies; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D013548:Sweden; D013710:Tendons / Q000637:transplantation*; D013977:Tibia / Q000601:surgery; D014182:Transplantation, Autologous; D055815:Young Adult
autografts; bone–patellar tendon–bone; epidemiology; graft failure; graft survival; hamstring tendon; knee injury; sports medicine; surgical revision