Original Article
Outcomes After Double-Bundle Anterior Cruciate Ligament Reconstruction

https://doi.org/10.1016/j.arthro.2017.07.027Get rights and content

Purpose

To identify the risk factors predicting unsatisfactory postoperative clinical outcomes after double-bundle (DB) anterior cruciate ligament (ACL) reconstruction using multivariate logistic regression.

Methods

Inclusion criteria were consecutive DB ACL reconstructions from January 2006 to September 2012 with a minimum 3-year follow-up. Exclusion criteria included (1) a delay to surgery from initial injury of more than 4 years (210 weeks); (2) contralateral knee pathology; (3) the lack of postoperative 3-dimensional computed tomography; (4) single-bundle ACL reconstruction; (5) revision ACL reconstruction; (6) meniscus allograft transplantation after total or subtotal meniscectomy; (7) multiple ligament surgeries. According to the overall International Knee Documentation Committee (IKDC) rating at the last follow-up, we sorted all enrolled subjects into superior (IKDC grade A or B) and inferior outcome groups (IKDC grade C or D). Multivariate logistic regression was used to analyze risk factors, including age, gender, body mass index, time from injury to surgery, posterior tibial slope, notch width index, cartilage injury, meniscus injury, and femoral and tibial tunnel positions.

Results

In comparison between the superior outcome group (n = 240) and inferior outcome group (n = 50), anterior (adjusted odds ratio [OR]: 0.902, 95% confidence interval [CI]: 0.846-0.962) or distal (adjusted OR: 1.025, 95% CI: 1.006-1.060) femoral anteromedial tunnel position was a significant risk factor for the inferior outcomes. Partial meniscectomy of medial (adjusted OR: 49.002, 95% CI: 7.047-340.717) or lateral (adjusted OR: 14.974, 95% CI: 2.181-102.790) meniscus and delayed time from injury to surgery (adjusted OR: 1.062, 95% CI: 1.023-1.102) were also a significant predictor.

Conclusion

Anterior or distal anteromedial femoral tunnel position, partial meniscectomy of medial or lateral meniscus, and prolonged surgical delay of more than 11.5 weeks from injury were significant risk factors for the inferior clinical outcomes after DB ACL reconstruction.

Level of Evidence

Level III, retrospective therapeutic case series.

Section snippets

Patients and Inclusion/Exclusion Criteria

After obtaining institutional review board approval for this retrospective trial, we reviewed the medical records of consecutive ACL reconstructions by one surgeon (J.H.A.) from January 2006 to September 2012. We started DB reconstruction since January 2005. Considering the learning period of 1 year and a minimum follow-up duration of 3 years, patients from January 2006 to September 2012 were enrolled. Patients were eligible for enrollment if they were at least 3 years out from DB ACL

Results

Among the 340 patients, 50 were ruled out after application of the exclusion criteria (Fig 5). Therefore, 290 DB ACL reconstructions with postoperative 3D-CT and a minimum 3-year follow-up were finally enrolled. According to the overall IKDC objective rating at the last follow-up, 290 enrolled DB ACL reconstructions were sorted into the superior outcomes (IKDC grade A or B, n = 240) and inferior outcomes groups (IKDC grade C or D, n = 50).

Demographic and clinical characteristics of each group

Discussion

The most important finding of the present study was that the specific risk factors that predicted the inferior postoperative outcomes were anterior or distal femoral AM tunnel position in postoperative 3D CT, partial meniscectomy of medial or lateral meniscus injury, and delayed time from injury to DB ACL reconstruction, especially more than 11.5 weeks from injury.

Various previous studies have addressed clinical and functional results according to the tunnel position after DB ACL reconstruction.

Conclusion

Anterior or distal AM femoral tunnel position, partial meniscectomy of medial or lateral meniscus, and prolonged surgical delay of more than 11.5 weeks from injury were significant risk factors for the inferior clinical outcomes after DB ACL reconstruction.

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    See commentary on page 231

    The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

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