Kaeding Christopher C, Pedroza Angela D, Reinke Emily K, Huston Laura J, Spindler Kurt P
Sports Health and Performance Institute, The Ohio State University, Columbus, Ohio, USA Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
Sports Health and Performance Institute, The Ohio State University, Columbus, Ohio, USA.
Am J Sports Med. 2015 Jul;43(7):1583-90. doi: 10.1177/0363546515578836. Epub 2015 Apr 21.
Anterior cruciate ligament (ACL) reinjury results in worse outcomes and increases the risk of posttraumatic osteoarthritis.
To identify the risk factors for both ipsilateral and contralateral ACL tears after primary ACL reconstruction (ACLR).
Cohort study; Level of evidence, 3.
Data from the Multicenter Orthopaedic Outcomes Network (MOON), a prospective longitudinal cohort, were used to identify risk factors for ACL retear. Subjects with primary ACLR, no history of contralateral knee surgery, and a minimum of 2-year follow-up data were included. Age, sex, Marx activity score, graft type, lateral meniscal tear, medial meniscal tear, sport played at index injury, and surgical facility were evaluated to determine their contribution to both ipsilateral retear and contralateral ACL tear.
A total of 2683 subjects with average age of 27 ± 11 years (1498 men; 56%) met all study inclusion/exclusion criteria. Overall there were 4.4% ipsilateral graft tears and 3.5% contralateral ACL tears. The odds of ipsilateral ACL retear were 5.2 times greater for an allograft (P < .01) compared with a bone-patellar tendon-bone (BTB) autograft; the odds of retear were not significantly different between BTB autograft and hamstring autograft (P = .12). The odds of an ipsilateral ACL retear decreased by 0.09 for every yearly increase in age (P < .01) and increased by 0.11 for every increased point on the Marx score (P < .01). These odds were not significantly influenced by sex, smoking status, sport played, medial or lateral meniscal tear, or consortium site (P > .05). The odds of a contralateral ACL tear decreased by 0.04 for every yearly increase in age (P = .04) and increased by 0.12 for every increased point on the Marx score (P < .01); these odds were not significantly different between sex, smoking status, sport played, graft type, medial meniscal tear, or lateral meniscal tear (P > .05).
Younger age, higher activity level, and allograft graft type were predictors of increased odds of ipsilateral graft failure. Higher activity and younger age were found to be risk factors in contralateral ACL tears.
前交叉韧带（ACL）再次损伤会导致更差的预后，并增加创伤后骨关节炎的风险。
确定初次ACL重建（ACLR）后同侧和对侧ACL撕裂的危险因素。
队列研究；证据等级，3级。
来自多中心骨科结局网络（MOON）的前瞻性纵向队列数据用于确定ACL再次撕裂的危险因素。纳入初次ACLR、无对侧膝关节手术史且至少有2年随访数据的受试者。评估年龄、性别、马克思活动评分、移植物类型、外侧半月板撕裂、内侧半月板撕裂、初次受伤时所从事的运动以及手术机构，以确定它们对同侧再次撕裂和对侧ACL撕裂的影响。
共有2683名平均年龄为27±11岁（1498名男性；56%）的受试者符合所有研究纳入/排除标准。总体而言，同侧移植物撕裂发生率为4.4%，对侧ACL撕裂发生率为3.5%。与骨-髌腱-骨（BTB）自体移植物相比，同种异体移植物同侧ACL再次撕裂的几率高5.2倍（P <.01）；BTB自体移植物和腘绳肌自体移植物之间再次撕裂的几率无显著差异（P =.12）。同侧ACL再次撕裂的几率随年龄每年增加而降低0.09（P <.01），随马克思评分每增加1分而增加0.11（P <.01）。这些几率不受性别、吸烟状况、所从事的运动、内侧或外侧半月板撕裂或联合研究点的显著影响（P >.05）。对侧ACL撕裂的几率随年龄每年增加而降低0.04（P =.04），随马克思评分每增加1分而增加0.12（P <.01）；这些几率在性别、吸烟状况、所从事的运动、移植物类型、内侧半月板撕裂或外侧半月板撕裂之间无显著差异（P >.05）。
年龄较小、活动水平较高和同种异体移植物类型是同侧移植物失败几率增加的预测因素。较高的活动水平和较年轻的年龄被发现是对侧ACL撕裂的危险因素。
