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Document Title: Dunn-AJSM-Dec04.shtml
Article Title: The Effect of Anterior Cruciate Ligament Reconstruction on the Risk of Knee Reinjury
Authors: Warren R. Dunn, MD, MPH, Stephen Lyman, PhD, Andrew E. Lincoln, ScD, MS, Paul J. Amoroso, MD, MPH, Thomas Wickiewicz, MD and Robert G. Marx, MD, MSc, FRCSC
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: December 2004
Volume 32, pages 1906-1914
Keywords: ACL reconstruction, injury prevention, injury-protective effect, reinjury, meniscal damage, articular-cartilage damage, outcome study, militarian population.
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Comments: This article, which looks at knee injuries in a population of militarians, shows that ACL reconstruction brings the benefit of preventing further injuries (e.g. meniscal tearing) to the knee. The benefits of ACL reconstruction are especially apparent if the surgery is undertaken within about 3 months of the actual injury. (If the knee is left ACL-deficient for longer periods of time, loosening of the secondary restraints will occur. This concern is especially the case if the knee is giving way on a regular basis, yet it is still present even if the person is able to keep the knee from giving out, e.g. through avoidance of certain movements. Although ACL reconstruction is still very beneficial even in a knee which has been ACLless for many years, the sloppiness in the knee motion might make repair of the stretched-out secondary restraints indicated.)
ABSTRACT
Background: Although there is evidence that very active, young patients are better served with anterior cruciate ligament reconstruction, there is a lack of objective data demonstrating that future knee injury is prevented by these procedures.
Hypothesis: Anterior cruciate ligament reconstruction protects against reinjury of the knee that would require reoperation.
Study Design: Retrospective cohort study.
Methods: A cohort of 6576 active-duty army personnel who had been hospitalized for anterior cruciate ligament injury from 1990 to 1996 were identified. Using the Total Army Injury and Health Outcomes Database, the authors followed these individuals for up to 9 years and collected clinical, demographic, and occupational data. These data were evaluated with bivariate and multivariable analyses to determine the effect of anterior cruciate ligament reconstruction on the rate of knee reinjury that required operation.
Results: Of the 6576 study subjects, 3795 subjects (58%) underwent anterior cruciate ligament reconstruction and 2781 (42%) did not. The rate of reoperation was significantly lower among the anterior cruciate ligament reconstruction group (4.90/100 person-years) compared with those treated conservatively (13.86/100 person-years; P < .0001). Proportional hazard regression analyses adjusted for age, race, sex, marital status, education, and physical activity level confirmed that anterior cruciate ligament reconstruction was protective against meniscal and cartilage reinjury (P < .0001). Secondary medial meniscal injury was more common than secondary lateral meniscal injury (P < .003). Younger age was the strongest predictor of failure of conservative management leading to late anterior cruciate ligament reconstruction (P < .0001).
Conclusions: Anterior cruciate ligament reconstruction protected against reoperation in this young, active population; younger subjects were more likely to require late anterior cruciate ligament reconstruction.
Clinical Relevance: Strong consideration should be given to anterior cruciate ligament reconstruction after anterior cruciate ligament injury in young, active individuals.
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