Predictors of Revision Surgery After Anterior Cruciate Ligament Reconstruction

• Published in: The American journal of sports medicine 2016-12, Vol.44 (12), p.3140-3145
• Main Authors: Pullen, W. Michael, Bryant, Brandon, Gaskill, Trevor, Sicignano, Nicholas, Evans, Amber M., DeMaio, Marlene
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anterior Cruciate Ligament Injuries - surgery; Anterior Cruciate Ligament Reconstruction - adverse effects; Anterior Cruciate Ligament Reconstruction - methods; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Arthroscopy - adverse effects; Arthroscopy - methods; Cyclooxygenase 2 Inhibitors - therapeutic use; Female; Graft Survival; Humans; Knee; Male; Middle Aged; Military Personnel; Nonsteroidal anti-inflammatory drugs; Odds Ratio; Patients; Postoperative Complications; Reoperation; Retrospective Studies; Risk Factors; Skin & tissue grafts; Sports medicine; Surgery; Young Adult
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546516660062

Background: Arthroscopically assisted anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. Graft failure after reconstruction remains a devastating complication, often requiring revision surgery and less aggressive or modified rehabilitation. Worse functional and patient-reported outcomes are reported compared with primary reconstruction. Moreover, both rates and risk factors for revision are variable and inconsistent within the literature. Purpose: To determine the rate of revision surgery after ACL reconstruction in a large cohort of patients, to assess the influence of patient characteristics on the odds of revision, and to compare revision rates between active-duty military members and non–active-duty beneficiaries. Study Design: Descriptive epidemiology study. Methods: Using administrative data from the Military Health System, a retrospective study was designed to characterize the rate of ACL revision surgery among patients treated within a military facility. All patients ≥18 years at the time of ACL reconstruction were identified using the American Medical Association Current Procedural Terminology (CPT) for ACL reconstruction (CPT code 29888) over 7 years (2005-2011). Revision ACL reconstructions were identified as having ≥2 ACL reconstruction procedure codes on the ipsilateral knee at least 90 days apart. Univariate analysis was performed to calculate odds ratios (ORs) for demographic, perioperative medication use, and concomitant procedure–related risk factors. A multivariate logistic regression model determined risk covariates in the active-duty cohort. Results: The study population consisted of 17,164 ACL reconstructions performed among 16,336 patients, of whom 83.3% were male with a mean ± SD age of 28.9 ± 7.6 years for the nonrevision group, and was predominantly active duty (89.2%). Patients undergoing ACL reconstruction on both knees only contributed their index knee for analyses. There were 587 patients who underwent revision surgery, corresponding to an overall revision rate of 3.6%. The median time from the index surgery to revision surgery was 500 days (interquartile range, 102-2406 days). Revision rates were higher in the active-duty cohort as compared with non–active-duty beneficiaries (3.8% vs 1.8%, respectively; OR, 2.14; 95% CI, 1.49-3.07). Based on multivariate logistic regression in the active-duty cohort, age ≥35 years (OR, 0.44; 95% CI, 0.33-0.58) and concomitant meniscal repair (OR, 0.69; 95% CI, 0