Allograft Anterior Cruciate Ligament Reconstruction Fails at a Greater Rate in Patients Younger Than 34 Years

Camryn B Petit; Jed A Diekfuss; Shayla M Warren; Kim D Barber Foss; Melanie Valencia; Staci M Thomas; Erich J Petushek; Spero G Karas; Kyle E Hammond; Mathew W Pombo; Sameh A Labib; Timothy S Maughon; Bryan J Whitfield; Gregory D Myer; John W Xerogeanes; Joseph D Lamplot

doi:10.1016/j.asmr.2023.04.024

Allograft Anterior Cruciate Ligament Reconstruction Fails at a Greater Rate in Patients Younger Than 34 Years

Arthrosc Sports Med Rehabil. 2023 Jun 10;5(4):100741. doi: 10.1016/j.asmr.2023.04.024. eCollection 2023 Aug.

Authors

Camryn B Petit^{1

2

3}, Jed A Diekfuss^{1

2

3}, Shayla M Warren¹, Kim D Barber Foss¹, Melanie Valencia¹, Staci M Thomas^{1

4}, Erich J Petushek^{1

5}, Spero G Karas^{2

3}, Kyle E Hammond^{2

3}, Mathew W Pombo^{2

3}, Sameh A Labib^{2

3}, Timothy S Maughon^{2

3}, Bryan J Whitfield^{2

3}, Gregory D Myer^{1

2

3}, John W Xerogeanes^{1

2

3}, Joseph D Lamplot^{1

6}

Affiliations

¹ Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, U.S.A.
² Emory Sports Medicine Center, Atlanta, Georgia, U.S.A.
³ Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, U.S.A.
⁴ Sports Medicine Division, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
⁵ Michigan Technological University, Houghton, Michigan, U.S.A.
⁶ Campbell Clinic, Germantown, Tennessee, U.S.A.

Abstract

Purpose: To characterize the secondary anterior cruciate ligament (ACL) injury rates after primary allograft anterior cruciate ligament reconstruction (ACLR) and to identify the age cut-score at which the risk of allograft failure decreases.

Methods: All patients who underwent primary ACLR within a single orthopaedic department between January 2005 and April 2020 were contacted at a minimum of 2 years post-ACLR to complete a survey regarding complications experienced post-surgery, activity level, and perceptions of knee health. Patients were excluded for incidence of previous ACLR (ipsilateral or contralateral) and/or age younger than 14 years. Relative proportions were calculated, binary regression analysis was performed, and receiver operating characteristic analysis was used to identify the threshold age for maximal sensitivity and specificity to predict high risk of allograft failure, defined as undergoing revision ACLR.

Results: Of the 939 surveys completed, 398 patients underwent primary allograft ACLR (mean age 39.5 years; range 16.0-66.1 years; 54.3% female). The secondary ACL injury rate was 11.6% (5.8% ipsilateral revision ACLR, 5.8% contralateral ACL injury). Male and female patients had similar revision (5.5% male, 6.0% female, P = .82) and contralateral ACL injury rates (6.6% male, 5.1% female, P = .52). Receiver operating characteristic analysis indicated that age ≤34 years was threshold for differentiating high risk of allograft failure (area under the curve 0.65, 95% confidence interval 0.55-0.76; P = .014). Patients aged ≤34 years had a greater secondary injury rate than patients >34 years (20.4% (10.2% revision ACLR, 10.2% contralateral ACL injury) versus 6.9% (3.5% revision ACLR, 3.5% contralateral ACL injury; P < .001). Binary regression analysis demonstrated that decreasing age was associated with increased risk of graft failure (χ² = 7.9, P = .02.).

Conclusions: Allograft ACLR showed similar failure rates between sexes but displayed suboptimal graft failure outcomes in younger and active patients. By age 34 years, the increased revision risk for younger patients diminished.

Level of evidence: Level IV, therapeutic case series.