Survival of anterior cruciate ligament reconstructions in active-duty military populations

被引:3
|
作者
Anderson, Ashley B. [1 ]
Dekker, Travis J. [2 ]
Pav, Veronika [3 ,4 ]
Mauntel, Timothy C. [5 ]
Provencher, Matthew T. [6 ]
Tokish, John M. [7 ]
Volker, Musahl [8 ]
Sansone, Michael [9 ,10 ]
Karlsson, Jon [9 ,10 ]
Dickens, Jonathan F. [1 ,9 ,10 ,11 ,12 ,13 ]
机构
[1] Uniformed Serv Univ Walter Reed, Natl Mil Med Ctr, Dept Surg Div Orthopaed, 8901 Wisconsin Ave, Bethesda, MD 20814 USA
[2] Eglin AFB, Dept Orthopaed, Eglin, FL USA
[3] Kennell & Associates Inc, Falls Church, VA USA
[4] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA
[5] DoD VA Extrem Trauma & Amputat Ctr Excellence, Ft Bragg, NC USA
[6] Steadman Philippon Res Inst, Vail, CO USA
[7] Mayo Clin, Scottsdale, AZ USA
[8] Univ Pittsburgh, Dept Orthopaed Surg, Med Ctr, Pittsburgh, PA USA
[9] Sahlgrens Univ Hosp, Dept Orthopaed, Sahlgrenska Acad, Gothenburg, Sweden
[10] Gothenburg Univ, Gothenburg, Sweden
[11] Duke Univ, Dept Orthopaed Surg, Durham, NC USA
[12] US Mil Acad, Keller Army Community Hosp, John A Feagin Jr Sports Med Fellowship, West Point, NY USA
[13] Duke Univ Hosp, Dept Orthopaed, Durham, NC USA
关键词
ACL; ACL survival; ACL outcomes; Risk factors for failure; REHABILITATION; PREDICTORS; CARTILAGE; SURGERY; INJURY; RETURN; KNEE;
D O I
10.1007/s00167-023-07335-w
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
PurposeAnterior cruciate ligament tears and anterior cruciate ligament reconstruction (ACLR) are common in young athletes. The modifiable and non-modifiable factors contributing to ACLR failure and reoperation are incompletely understood. The purpose of this study was to determine ACLR failure rates in a physically high-demand population and identify the patient-specific risk factors, including prolonged time between diagnosis and surgical correction, that portend failure.MethodsA consecutive series of military service members with ACLR with and without concomitant procedures (meniscus [M] and/or cartilage [C]) done at military facilities between 2008 and 2011 was completed via the Military Health System Data Repository. This was a consecutive series of patients without a history of knee surgery for two years prior to the primary ACLR. Kaplan-Meier survival curves were estimated and evaluated with Wilcoxon test. Cox proportional hazard models calculated hazard ratios (HR) with 95% confidence intervals (95% CI) to identify demographic and surgical factors that influenced ACLR failure.ResultsOf the 2735 primary ACLRs included in the study, 484/2,735 (18%) experienced ACLR failure within four years, including (261/2,735) (10%) undergoing revision ACLR and (224/2,735) (8%) due to medical separation. The factors that increased failure include Army Service (HR 2.19, 95% CI 1.67, 2.87), > 180 days from injury to ACLR (HR 1.550, 95% CI 1.157, 2.076), tobacco use (HR 1.429 95% CI 1.174, 1.738), and younger patient age (HR 1.024, 95% CI 1.004, 1.044).ConclusionThe overall clinical failure rate of service members with ACLR is 17.7% with minimum four-year follow-up, where more patients are likely to fail due to revision surgery than medical separation. The cumulative probability of survival at 4 years was 78.5%. Smoking cessation and treating ACLR patients promptly are modifiable risk factors impacting either graft failure or medical separation.
引用
收藏
页码:3196 / 3203
页数:8
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