Young age and small grafts may increase the odds of ACL re-tear

Young patients and small grafts may have higher odds of re-tear after an anterior cruciate ligament reconstruction, new research suggests.

Danielle Konig, 13, has tested the smaller ball and was surprised how much lighter it was. Peter Power For The Globe and Mail

Danielle Konig, 13, has tested the smaller ball and was surprised how much lighter it was. Peter Power for The Globe and Mail

The odds of a re-tear may be seven times higher in patients younger than 25 years old and three times higher if the graft is smaller than 8 mm, according to data presented July 7 at the American Orthopaedic Society for Sports Medicine’s annual meeting in Colorado Springs, Colorado.

By Rob Goodier, Medscape July 12, 2016

Women may also be at risk with 1.8-fold higher odds of re-tear, but the association was not statistically significant.

Physicians should counsel those patients and consider modifying their surgical or rehabilitation methods, Dr. Duong Nguyen, an orthopedic surgeon based in Toronto, Canada, who led the study, told Reuters Health by email.

“ACL re-tear is multifactorial and physicians should also consider other potential causes such as the specific sport played, the athlete’s level of competition and position on the team, the extent of contact in the sports activity, and the patient’s tendency for risk taking behavior, which are harder to quantify and control in a study,” Dr. Nguyen says.

The study followed 503 athletes for two years after they underwent a primary autograft hamstring ACL reconstruction. The surgery was by a single surgeon using the same technique and rehabilitation regimen.

Multivariate logistic regression found that patients younger than 25 had an odds ratio of re-tear of 7.01 (p=0.001). Graft size of less than 8 mm had an odds ratio of 2.95 (p=0.008). Univariate analysis suggested that women may have higher odds of suffering a re-tear, but it was not statistically significant (OR: 1.8).

All patients should be warned of ACL reconstruction risks, and, if asked, surgeons could add information about the two or three risk factors examined in this study, says Dr. Barry Boden, a professor of orthopedic surgery at Uniformed Services University of the Health Sciences in Bethesda, Maryland, who was not involved in the research.

“I do agree with the conclusions that surgeons may wish to modify their surgical technique and rehabilitation when these conditions exist. Although no graft is perfect, this is one reason why I tend to favor the bone-patella tendon-bone graft in young patients,” Dr. Boden says.

Source American Orthopaedic Society for Sports Medicin, AOSSM via Medscape

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