The American Journal of Sports Medicine http://ajs.sagepub.com/
Return to Sports and Subsequent Injury Rates After Revision Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft K. Donald Shelbourne, Rodney W. Benner and Tinker Gray Am J Sports Med 2014 42: 1395 originally published online March 13, 2014 DOI: 10.1177/0363546514524921 The online version of this article can be found at: http://ajs.sagepub.com/content/42/6/1395
Published by: http://www.sagepublications.com
On behalf of: American Orthopaedic Society for Sports Medicine
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Return to Sports and Subsequent Injury Rates After Revision Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft K. Donald Shelbourne,*y MD, Rodney W. Benner,y MD, and Tinker Gray,y MA Investigation performed at Shelbourne Knee Center, Indianapolis, Indiana, USA Background: The return-to-sport and reinjury rates are not well defined after revision anterior cruciate ligament (ACL) reconstruction. Hypothesis: School-age athletes would have a higher rate of return to sports and reinjury to either knee after revision ACL surgery compared with college or recreational athletes. Study Design: Cohort study; Level of evidence, 2. Methods: Patients were prospectively studied after revision ACL reconstruction with bone-patellar tendon-bone (BPTB) autograft. Participants were grouped by competitive sport levels of school age (mean age, 16.6 6 0.9 years; n = 84), college (19.6 6 1.2 years; n = 58), or recreational adult (27.6 6 4.1 years; n = 117). An activity survey was used to determine the specific sport and sport level patients participated in before and after surgery. The International Knee Documentation Committee (IKDC) knee survey and Cincinnati Knee Rating System (CKRS) survey responses were also obtained. Results: The rate of return to the same sport at the same level was 62 of 84 school-age athletes (74%), 43 of 58 college athletes (74%), and 73 of 117 recreational athletes (62%) (P = .1065). The number of patients who had a subsequent ACL graft tear rate after revision surgery was 2 of 84 (2.3%) in the high school group, 3 of 58 (5.1%) in the college group, and 4 of 117 (3.4%) in the recreational group (P = .6706). The number of patients who had a subsequent ACL tear in the contralateral knee was 1 of 84 (1.1%) in the school-age group, 1 of 58 (1.7%) in the college group, and 2 of 117 (1.7%) in the recreational group (P = .9501). At 2 years postoperatively, the mean IKDC subjective total score was 86.1 6 11.7 points and the mean CKRS total score was 89.7 6 11.1 points. Conclusion: Revision ACL reconstruction with BPTB autograft and perioperative rehabilitation allowed high school and college athletes to return to sports at the preinjury level at a rate of 74%; the return rate for recreational-level adults was 62%. Reinjury rates in the first 5 years after revision surgery ranged from 2% to 5%, which is lower than what has been reported for young competitive athletes after primary surgery. Keywords: anterior cruciate ligament; reconstruction; revision; reinjury; sports; graft choice
these athletes are considered ideal candidates for ACL reconstruction. However, return to the previous level of competition after surgery is not a certainty, with some series reporting return-to-sport rates from 50% to 75% after primary ACL reconstruction.4,11 Furthermore, young competitive athletes and athletes returning to strenuous activities are the highest risk with regard to reinjury to either the reconstructed ACL graft or the contralateral ACL.18 Shelbourne et al18 reported reinjury rates to either knee for all patients within 5 years after ACL surgery and found that 5.3% tore their contralateral ACL, while 4.3% retore their surgically reconstructed ACL graft. Young athletes younger than 18 years, however, had higher rate of reinjury to either knee, with an incidence of 17.4%. Salmon et al16 found a similar difference in reinjury rates based on International Knee Documentation Committee (IKDC)
Anterior cruciate ligament (ACL) reconstruction is a common surgical procedure in competitive athletes at the high school and collegiate levels. Given their young age, active lifestyle, and risk of future instability episodes,
*Address correspondence to K. Donald Shelbourne, MD, Shelbourne Knee Center, 1815 N Capitol Avenue, Indianapolis, IN 46202 (e-mail: [email protected]). y Shelbourne Knee Center, Indianapolis, Indiana, USA. Presented at the 39th annual meeting of the AOSSM, Chicago, Illinois, July 2013. The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. The American Journal of Sports Medicine, Vol. 42, No. 6 DOI: 10.1177/0363546514524921 Ó 2014 The Author(s)
1395 Downloaded from ajs.sagepub.com at COLUMBIA UNIV on March 2, 2015
1396 Shelbourne et al
The American Journal of Sports Medicine
TABLE 1 Sports Activity by Competitive Sport Groupa Activity Basketball Soccer Football Volleyball Other sportsb
School-Age 37 18 11 8 10
(44) (21) (13) (10) (12)
College 24 13 12 5 4
(41) (22) (21) (9) (7)
Revision ACL surgery between 1994-2007 (N=378) Excluded (n=76) Not involved in pivoting, twisting, jumping sport (n= 56) For patients
Return to Sports and Subsequent Injury Rates After Revision Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft K. Donald Shelbourne, Rodney W. Benner and Tinker Gray Am J Sports Med 2014 42: 1395 originally published online March 13, 2014 DOI: 10.1177/0363546514524921 The online version of this article can be found at: http://ajs.sagepub.com/content/42/6/1395
Published by: http://www.sagepublications.com
On behalf of: American Orthopaedic Society for Sports Medicine
Additional services and information for The American Journal of Sports Medicine can be found at: Email Alerts: http://ajs.sagepub.com/cgi/alerts Subscriptions: http://ajs.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> Version of Record - May 30, 2014 OnlineFirst Version of Record - Mar 13, 2014 What is This?
Downloaded from ajs.sagepub.com at COLUMBIA UNIV on March 2, 2015
Return to Sports and Subsequent Injury Rates After Revision Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft K. Donald Shelbourne,*y MD, Rodney W. Benner,y MD, and Tinker Gray,y MA Investigation performed at Shelbourne Knee Center, Indianapolis, Indiana, USA Background: The return-to-sport and reinjury rates are not well defined after revision anterior cruciate ligament (ACL) reconstruction. Hypothesis: School-age athletes would have a higher rate of return to sports and reinjury to either knee after revision ACL surgery compared with college or recreational athletes. Study Design: Cohort study; Level of evidence, 2. Methods: Patients were prospectively studied after revision ACL reconstruction with bone-patellar tendon-bone (BPTB) autograft. Participants were grouped by competitive sport levels of school age (mean age, 16.6 6 0.9 years; n = 84), college (19.6 6 1.2 years; n = 58), or recreational adult (27.6 6 4.1 years; n = 117). An activity survey was used to determine the specific sport and sport level patients participated in before and after surgery. The International Knee Documentation Committee (IKDC) knee survey and Cincinnati Knee Rating System (CKRS) survey responses were also obtained. Results: The rate of return to the same sport at the same level was 62 of 84 school-age athletes (74%), 43 of 58 college athletes (74%), and 73 of 117 recreational athletes (62%) (P = .1065). The number of patients who had a subsequent ACL graft tear rate after revision surgery was 2 of 84 (2.3%) in the high school group, 3 of 58 (5.1%) in the college group, and 4 of 117 (3.4%) in the recreational group (P = .6706). The number of patients who had a subsequent ACL tear in the contralateral knee was 1 of 84 (1.1%) in the school-age group, 1 of 58 (1.7%) in the college group, and 2 of 117 (1.7%) in the recreational group (P = .9501). At 2 years postoperatively, the mean IKDC subjective total score was 86.1 6 11.7 points and the mean CKRS total score was 89.7 6 11.1 points. Conclusion: Revision ACL reconstruction with BPTB autograft and perioperative rehabilitation allowed high school and college athletes to return to sports at the preinjury level at a rate of 74%; the return rate for recreational-level adults was 62%. Reinjury rates in the first 5 years after revision surgery ranged from 2% to 5%, which is lower than what has been reported for young competitive athletes after primary surgery. Keywords: anterior cruciate ligament; reconstruction; revision; reinjury; sports; graft choice
these athletes are considered ideal candidates for ACL reconstruction. However, return to the previous level of competition after surgery is not a certainty, with some series reporting return-to-sport rates from 50% to 75% after primary ACL reconstruction.4,11 Furthermore, young competitive athletes and athletes returning to strenuous activities are the highest risk with regard to reinjury to either the reconstructed ACL graft or the contralateral ACL.18 Shelbourne et al18 reported reinjury rates to either knee for all patients within 5 years after ACL surgery and found that 5.3% tore their contralateral ACL, while 4.3% retore their surgically reconstructed ACL graft. Young athletes younger than 18 years, however, had higher rate of reinjury to either knee, with an incidence of 17.4%. Salmon et al16 found a similar difference in reinjury rates based on International Knee Documentation Committee (IKDC)
Anterior cruciate ligament (ACL) reconstruction is a common surgical procedure in competitive athletes at the high school and collegiate levels. Given their young age, active lifestyle, and risk of future instability episodes,
*Address correspondence to K. Donald Shelbourne, MD, Shelbourne Knee Center, 1815 N Capitol Avenue, Indianapolis, IN 46202 (e-mail: [email protected]). y Shelbourne Knee Center, Indianapolis, Indiana, USA. Presented at the 39th annual meeting of the AOSSM, Chicago, Illinois, July 2013. The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. The American Journal of Sports Medicine, Vol. 42, No. 6 DOI: 10.1177/0363546514524921 Ó 2014 The Author(s)
1395 Downloaded from ajs.sagepub.com at COLUMBIA UNIV on March 2, 2015
1396 Shelbourne et al
The American Journal of Sports Medicine
TABLE 1 Sports Activity by Competitive Sport Groupa Activity Basketball Soccer Football Volleyball Other sportsb
School-Age 37 18 11 8 10
(44) (21) (13) (10) (12)
College 24 13 12 5 4
(41) (22) (21) (9) (7)
Revision ACL surgery between 1994-2007 (N=378) Excluded (n=76) Not involved in pivoting, twisting, jumping sport (n= 56) For patients
