title: Long-term rate of graft failure after ACL reconstruction: a geographic population cohort analysis.
abstract: OBJECTIVE
  Graft failure following anterior cruciate ligament reconstruction (ACLR) is a devastating injury among patients returning to activity. The goals of this study were to define the long-term rate of graft failure after ACLR in the general population and evaluate factors associated with graft failure.
  
  
  METHODS
  This long-term observational study included a population-based incidence cohort of patients who underwent primary ACLR after diagnosis with new-onset, isolated ACL tears between 1990 and 2010. For all patients, a chart review was performed to collect information related to the initial injury, treatment, and outcomes. Patients were retrospectively followed to determine the incidence of graft failure following ACLR.
  
  
  RESULTS
  The study cohort consisted of 1355 patients with new-onset, isolated ACL tears treated with ACLR. At a mean follow-up of 10.0 years (±6.4 years) following ACLR, a total of 72 patients (5.3 %) sustained ipsilateral graft failure. The graft survival following ACLR was 99.7 % at 1 year, 96 % at 5 years, 94 % at 10 years, 93 % at 15 years, 92 % at 20 years and 91 % at 25 years. Among patients 22 years or younger (n = 571), the rate of graft failure was significantly higher compared to patients older than 22 years (6.3 vs. 4.6 %, p = 0.04). The rate of graft failure decreased significantly over the 21-year observation period of this study (p < 0.0001).
  
  
  CONCLUSIONS
  Among all patients receiving primary ACLR, graft failure remains an uncommon but functionally devastating outcome with an estimated graft survival rate of 91 % at 25 years following surgery. Patients aged 22 or younger had a significantly higher rate of graft failure than older patients. The rate of graft failure decreased over the 21-year span of this study.
  
  
  METHODS
  Retrospective case series, Level IV.
authors: Departments of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. sanders.thomas@mayo.edu.
authors: Thomas L
authors: http://orcid.org/0000-0001-7741-9692
authors: TL
authors: Sanders
authors: Departments of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors: Ayoosh
authors: A
authors: Pareek
authors: Departments of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors: Timothy E
authors: TE
authors: Hewett
authors: Departments of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors: Bruce A
authors: BA
authors: Levy
authors: Departments of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors: Diane L
authors: DL
authors: Dahm
authors: Departments of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors: Michael J
authors: MJ
authors: Stuart
authors: Departments of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors: Aaron J
authors: AJ
authors: Krych
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries / Q000150:complications / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D016025:Bone Transplantation; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D000070632:Hamstring Tendons / Q000637:transplantation; D006801:Humans; D015994:Incidence; D007718:Knee Injuries / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017847:Patellar Ligament / Q000637:transplantation; D011183:Postoperative Complications / Q000453:epidemiology*; D012008:Recurrence; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation*; D000070600:Tibial Meniscus Injuries / Q000150:complications / Q000601:surgery; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D055815:Young Adult
keywords: ACL; Anterior cruciate ligament; Graft disruption; Retear