The Effect of Anterior Cruciate Ligament Reconstruction on the Risk of Knee Reinjury

• Published in: The American journal of sports medicine Vol. 32; no. 8; pp. 1906 - 1914
• Main Authors: Dunn, Warren R., Lyman, Stephen, Lincoln, Andrew E., Amoroso, Paul J., Wickiewicz, Thomas, Marx, Robert G.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA American Orthopaedic Society for Sports Medicine 01-12-2004; SAGE Publications; Sage Publications, Inc; Sage Publications Ltd
• Subjects: Adult; Adverse and side effects; Age Factors; Anterior cruciate ligament; Anterior Cruciate Ligament - surgery; Anterior Cruciate Ligament Injuries; Biological and medical sciences; Care and treatment; Cartilage, Articular - injuries; Cartilage, Articular - surgery; Clinical outcomes; Cohort Studies; Female; Humans; Injuries; Knee; Knee injuries; Knee Injuries - prevention & control; Knee Injuries - surgery; Ligaments; Male; Medical sciences; Menisci, Tibial - surgery; Middle Aged; Military Personnel; Miscellaneous; Multivariate analysis; Occupational medicine; Outcome Assessment (Health Care); Proportional Hazards Models; Public health. Hygiene-occupational medicine; Reoperation - statistics & numerical data; Retrospective Studies; Secondary Prevention; Sports injuries; Tibial Meniscus Injuries; Young adults; United States; reinjury; outcome study; reoperation; military; injury; adult; anterior cruciate ligament (ACL); Knee; Human; Reconstruction; Reoperation; Army; Hospitalization; Method; Personnel; Epidemiology; Anterior cruciate ligament; Design; Prevention; Work safety; Cohort study; Risk factor; Procedure; Public health; Hazard
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546504265006

Background: Although there is evidence that very active, young patients are better served with anterior cruciate ligament reconstruction,
there is a lack of objective data demonstrating that future knee injury is prevented by these procedures.
Hypothesis: Anterior cruciate ligament reconstruction protects against reinjury of the knee that would require reoperation.
Study Design: Retrospective cohort study.
Methods: A cohort of 6576 active-duty army personnel who had been hospitalized for anterior cruciate ligament injury from 1990 to
1996 were identified. Using the Total Army Injury and Health Outcomes Database, the authors followed these individuals for
up to 9 years and collected clinical, demographic, and occupational data. These data were evaluated with bivariate and multivariable
analyses to determine the effect of anterior cruciate ligament reconstruction on the rate of knee reinjury that required operation.
Results: Of the 6576 study subjects, 3795 subjects (58%) underwent anterior cruciate ligament reconstruction and 2781 (42%) did not.
The rate of reoperation was significantly lower among the anterior cruciate ligament reconstruction group (4.90/100 person-years)
compared with those treated conservatively (13.86/100 person-years; P < .0001). Proportional hazard regression analyses adjusted for age, race, sex, marital status, education, and physical activity
level confirmed that anterior cruciate ligament reconstruction was protective against meniscal and cartilage reinjury ( P < .0001). Secondary medial meniscal injury was more common than secondary lateral meniscal injury ( P < .003). Younger age was the strongest predictor of failure of conservative management leading to late anterior cruciate
ligament reconstruction ( P < .0001).
Conclusions: Anterior cruciate ligament reconstruction protected against reoperation in this young, active population; younger subjects
were more likely to require late anterior cruciate ligament reconstruction.
Clinical Relevance: Strong consideration should be given to anterior cruciate ligament reconstruction after anterior cruciate ligament injury
in young, active individuals.
Keywords:
adult
anterior cruciate ligament (ACL)
injury
reinjury
reoperation
military
outcome study