Halperin Scott J, Dhodapkar Meera M, McLaughlin William M, Hewett Timothy E, Grauer Jonathan N, Medvecky Michael J
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA.
Department of Orthopaedics, Marshall University School of Medicine, Huntington, West Virginia, USA.
Orthop J Sports Med. 2024 Oct 4;12(10):23259671241274671. doi: 10.1177/23259671241274671. eCollection 2024 Oct.
After anterior cruciate ligament (ACL) reconstruction (ACLR), ipsilateral ACL graft reinjury or contralateral ACL injury has been reported. The rate and predictors of such subsequent ACL injuries have not been reported in recent years and in large patient cohorts.
The current study utilized a large, national, multi-insurance, administrative database to assess subsequent ACLR and factors associated with its occurrence.
Cross-sectional study; Level of evidence, 3.
Using the PearlDiver M151 database, patients who underwent ACLR within the United States between 2015 and 2021 were abstracted. All included patients had ≥3 years of evaluation after initial ACLR. Patients who underwent a subsequent reconstruction (ipsilateral or contralateral) within 3 years were determined and the timing assessed. Using univariable and multivariable logistic regression, the factors associated with having a subsequent ACLR and the factors associated with returning for ipsilateral versus contralateral ACLR were examined.
In total, 40,151 patients who underwent initial ACLR during the study period were identified. Of these, subsequent ACLR was performed for 1689 patients (4.2%). These included ipsilateral revision for 1018 (60.3%) and contralateral reconstruction for 671 (39.7%) patients. Patients returning for ipsilateral reconstruction did so sooner than patients needing a contralateral reconstruction. On multivariable analysis, the only factor independently associated with subsequent ACLR was younger age (odds ratio [OR] = 4.17 for 10-14 years relative to 25-29 years; < .0001). Factors associated with returning for an ipsilateral revision ACLR as opposed to contralateral ACLR were earlier revision (OR = 1.49 within 1.5 years relative to after 1.5 years; = .0001) and female sex (OR = 0.62 relative to male sex; < .0001).
The overall rate of requiring a subsequent ACLR was found to be 4.2%, with 60.3% of these being to the ipsilateral ACL. This information may be helpful for evolving injury-prevention programs and patient counseling.
据报道，在前交叉韧带（ACL）重建术（ACLR）后，会出现同侧ACL移植物再损伤或对侧ACL损伤。近年来，在大型患者队列中尚未报道此类后续ACL损伤的发生率及预测因素。
本研究利用一个大型的全国性多保险行政数据库，评估后续的ACLR及其发生相关因素。
横断面研究；证据等级，3级。
使用PearlDiver M151数据库，提取2015年至2021年在美国接受ACLR的患者。所有纳入患者在初次ACLR后有≥3年的随访。确定在3年内接受后续重建术（同侧或对侧）的患者，并评估其时间。采用单变量和多变量逻辑回归，研究与后续ACLR相关的因素以及与同侧与对侧ACLR再手术相关的因素。
在研究期间，共确定了40151例接受初次ACLR的患者。其中，1689例患者（4.2%）接受了后续ACLR。包括1018例（60.3%）同侧翻修和671例（39.7%）对侧重建。同侧重建的患者比需要对侧重建的患者更早进行手术。多变量分析显示，与后续ACLR独立相关的唯一因素是年龄较小（相对于25 - 29岁，10 - 14岁的比值比[OR]=4.17；P<0.0001）。与对侧ACLR相比，同侧翻修ACLR再手术相关的因素是更早翻修（相对于1.5年后，1.5年内的OR = 1.49；P = 0.0001）和女性（相对于男性，OR = 0.62；P<0.0001）。
发现需要进行后续ACLR的总体发生率为4.2%，其中60.3%为同侧ACL。这些信息可能有助于改进损伤预防方案和患者咨询。
