A High Tibial Slope, Allograft Use, and Poor Patient-Reported Outcome Scores Associated with Multiple ACL Graft Failures

January 7, 2022

A study recently published in Knee Surgery, Sports Traumatology, Arthroscopy to discuss ACL graft failures was conducted by several orthopaedic experts including UPMC Orthopaedic Care physicians Jonathan Hughes, MD, Bryson Lesniak, MD, and Volker Musahl, MD.

The purpose of the study was to compare clinical outcomes, radiographic characteristics, and surgical factors between patients with single and multiple anterior cruciate ligament (ACL) graft failures. It was hypothesized that patients experiencing multiple ACL graft failures exhibit lower patient-reported outcome scores (PROs) and a higher (steeper) posterior tibial slope (PTS) than patients with single ACL graft failure.

Patients undergoing revision ACL reconstruction with a minimum follow-up of 12 months were included in this retrospective cohort study. Based on the number of ACL graft failures, patients were assigned either to the group “single ACL graft failure” or “multiple ACL graft failures.” The PTS was measured on strict lateral radiographs. Validated PROs including the International Knee Documentation Committee (IKDC) subjective knee form, Knee Injury and Osteoarthritis Outcome Score, Lysholm Score, Tegner Activity Scale, ACL-Return to Sport after Injury Scale, and Visual Analogue Scale for pain were collected.

Overall, 102 patients were included with 58 patients assigned to the single ACL graft failure group and 44 patients to the multiple ACL graft failures group.

Compared to single ACL graft failure in this study, multiple ACL graft failures were associated with worse PROs, higher PTS, and allograft use. During the first revision ACL reconstruction, it is recommended to avoid the use of allografts and to consider slope-reducing osteotomies to avoid multiple ACL graft failures and improve PROs.

Read more about this study on SpringerLink.

Other study authors include Philipp Winkler, MD, and Nyaluma Wagala, MD.