title: Factors That Predict Failure in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction.
abstract: BACKGROUND
  Anatomic graft placement in anterior cruciate ligament (ACL) reconstruction has become the preferred technique for many surgeons. The predictive factors for graft failure in anatomic single-bundle ACL reconstruction are relatively unknown.
  
  
  OBJECTIVE
  To determine the risk factors for graft failure and the relative importance of those factors in anatomic single-bundle ACL reconstruction.
  
  
  METHODS
  Case-control study; Level of evidence, 3.
  
  
  METHODS
  All primary anatomic ACL reconstructions undertaken at a single institution over a 2-year period were evaluated for subjective and objective measures of graft failure. Risk factors evaluated included time since ACL rupture, age, sex, body mass index, intact or deficient medial and lateral meniscus, meniscal repair, hamstring graft size, and femoral and tibial tunnel position as assessed by 3D computed tomography (CT) scan. The significant factors predicting failure and the relative importance of those factors were determined.
  
  
  RESULTS
  At a median follow-up of 26 months, 123 patients were available for analysis. Ninety-seven patients underwent postoperative 3D CT for tunnel positions, including all 20 cases with graft failure. The significant predictors of graft failure were medial meniscal deficiency (hazard ratio [HR] 15.1; 95% CI, 4.7-48.5; P < .001), lateral meniscal deficiency (HR 9.9; 95% CI, 3-33; P < .001), shallow nonanatomic femoral tunnel positioning (HR 4.3; 95% CI, 1.6-11.6; P = .004), and younger patient age (HR 0.9; 95% CI, 0.9-1; P = .008).
  
  
  CONCLUSIONS
  Meniscal deficiency is the most significant factor to predict graft failure in single-bundle anatomic ACL reconstruction. Shallow nonanatomic femoral tunnel positioning and younger patient age are additional risk factors for failure, but their relative importance is less.
authors.affiliation: Department of Orthopaedics, Cairns Hospital, Cairns, Queensland, Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: Parkinson
authors.affiliation: Warrington and Halton NHS Trust, Warrington, UK.
authors.forename: Curtis
authors.initials: C
authors.lastname: Robb
authors.affiliation: University Hospitals Coventry and Warwickshire (UHCW), Coventry, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Thomas
authors.affiliation: University Hospitals Coventry and Warwickshire (UHCW), Coventry, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Thompson
authors.affiliation: University Hospitals Coventry and Warwickshire (UHCW), Coventry, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Spalding
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012307:Risk Factors; D012737:Sex Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
keywords: anatomic ACL reconstruction; anterior cruciate ligament; failure; meniscus; single bundle; tunnel position