Graft Choice for Anterior Cruciate Ligament Reconstruction With a Concomitant Non-surgically Treated Medial Collateral Ligament Injury Does Not Influence the Risk of Revision

Eleonor Svantesson, Eric Hamrin Senorski, Matilda Östergaard, Alberto Grassi, Ferid Krupic, Olof Westin, Kristian Samuelsson

Research output: Contribution to journalArticle

Abstract

PURPOSE: To compare the risk of anterior cruciate ligament (ACL) revision and the patient-reported outcome after ACL reconstruction with a concomitant non-surgically treated medial collateral ligament (MCL) injury with regard to 3 ACL graft choices; the use of semitendinosus (ST), the use of semitendinosus-gracilis (ST-G), and the use of patellar tendon (PT) autograft. It was hypothesized that the use of ST-G would be associated with a greater risk of ACL revision and poorer patient-reported knee function.

METHODS: Patients older than 15 years of age registered for a primary ACL reconstruction with a concomitant non-surgically treated MCL injury in the Swedish National Knee Ligament Registry were assessed for eligibility. Three groups were created according to ACL autograft choice; the ST, the ST-G, and the PT group. The primary outcomes were ACL revision and the 1- and 2-year Knee injury and Osteoarthritis Outcome Score (KOOS), including the KOOS patient acceptable symptom state (PASS). Cox regression analysis was applied to determine the proportional hazard ratio (HR) of primary ACL reconstruction survival. The KOOS was compared using the Mann-Whitney U test and Fisher exact test.

RESULTS: A total of 622 patients (mean age 29.7 years, 42.4% women) were included. There was no difference in the risk of ACL revision for either the ST group (HR 1.354; 95% confidence interval [CI] 0.678-2.702 or the PT group (HR 0.837; 95% CI 0.334-2.100), compared with the ST-G group. The ST group reported a greater mean 2-year KOOS sports and recreation (68.5, standard deviation [SD] 28.5) than the ST-G group (57.4 [SD 27.6], P = .010) and the PT group (54.1 [SD 30.3], P = .006). The ST group was superior in terms of achieving PASS in sports and recreation (55.3%; 95% CI 44.1-66.1%) compared with both the ST-G (37.4%; 95% CI 29.8-45.5%; P = .014) and the PT group (33.9%; 95% CI 22.1-47.4%; P = .009).

CONCLUSIONS: The risk of ACL revision did not differ between HT and PT autografts in patients undergoing ACL reconstruction with a non-surgically treated MCL injury. However, the use of ST-G was associated with poorer 2-year patient-reported knee function compared with the ST.

LEVEL OF EVIDENCE: Retrospective comparative trial, Level III.

Fingerprint

Collateral Ligaments
Anterior Cruciate Ligament Reconstruction
Transplants
Anterior Cruciate Ligament
Patellar Ligament
Wounds and Injuries
Knee Injuries
Knee Osteoarthritis
Confidence Intervals
Autografts
Recreation
Knee
Hamstring Muscles
Sports
Nonparametric Statistics
Ligaments
Registries

Cite this

@article{1a59872e525e423ab05978c3b4191954,
title = "Graft Choice for Anterior Cruciate Ligament Reconstruction With a Concomitant Non-surgically Treated Medial Collateral Ligament Injury Does Not Influence the Risk of Revision",
abstract = "PURPOSE: To compare the risk of anterior cruciate ligament (ACL) revision and the patient-reported outcome after ACL reconstruction with a concomitant non-surgically treated medial collateral ligament (MCL) injury with regard to 3 ACL graft choices; the use of semitendinosus (ST), the use of semitendinosus-gracilis (ST-G), and the use of patellar tendon (PT) autograft. It was hypothesized that the use of ST-G would be associated with a greater risk of ACL revision and poorer patient-reported knee function.METHODS: Patients older than 15 years of age registered for a primary ACL reconstruction with a concomitant non-surgically treated MCL injury in the Swedish National Knee Ligament Registry were assessed for eligibility. Three groups were created according to ACL autograft choice; the ST, the ST-G, and the PT group. The primary outcomes were ACL revision and the 1- and 2-year Knee injury and Osteoarthritis Outcome Score (KOOS), including the KOOS patient acceptable symptom state (PASS). Cox regression analysis was applied to determine the proportional hazard ratio (HR) of primary ACL reconstruction survival. The KOOS was compared using the Mann-Whitney U test and Fisher exact test.RESULTS: A total of 622 patients (mean age 29.7 years, 42.4{\%} women) were included. There was no difference in the risk of ACL revision for either the ST group (HR 1.354; 95{\%} confidence interval [CI] 0.678-2.702 or the PT group (HR 0.837; 95{\%} CI 0.334-2.100), compared with the ST-G group. The ST group reported a greater mean 2-year KOOS sports and recreation (68.5, standard deviation [SD] 28.5) than the ST-G group (57.4 [SD 27.6], P = .010) and the PT group (54.1 [SD 30.3], P = .006). The ST group was superior in terms of achieving PASS in sports and recreation (55.3{\%}; 95{\%} CI 44.1-66.1{\%}) compared with both the ST-G (37.4{\%}; 95{\%} CI 29.8-45.5{\%}; P = .014) and the PT group (33.9{\%}; 95{\%} CI 22.1-47.4{\%}; P = .009).CONCLUSIONS: The risk of ACL revision did not differ between HT and PT autografts in patients undergoing ACL reconstruction with a non-surgically treated MCL injury. However, the use of ST-G was associated with poorer 2-year patient-reported knee function compared with the ST.LEVEL OF EVIDENCE: Retrospective comparative trial, Level III.",
author = "Eleonor Svantesson and {Hamrin Senorski}, Eric and Matilda {\"O}stergaard and Alberto Grassi and Ferid Krupic and Olof Westin and Kristian Samuelsson",
note = "Copyright {\circledC} 2019 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.",
year = "2019",
month = "9",
day = "13",
doi = "10.1016/j.arthro.2019.07.015",
language = "English",
journal = "Arthroscopy - Journal of Arthroscopic and Related Surgery",
issn = "0749-8063",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Graft Choice for Anterior Cruciate Ligament Reconstruction With a Concomitant Non-surgically Treated Medial Collateral Ligament Injury Does Not Influence the Risk of Revision

AU - Svantesson, Eleonor

AU - Hamrin Senorski, Eric

AU - Östergaard, Matilda

AU - Grassi, Alberto

AU - Krupic, Ferid

AU - Westin, Olof

AU - Samuelsson, Kristian

N1 - Copyright © 2019 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

PY - 2019/9/13

Y1 - 2019/9/13

N2 - PURPOSE: To compare the risk of anterior cruciate ligament (ACL) revision and the patient-reported outcome after ACL reconstruction with a concomitant non-surgically treated medial collateral ligament (MCL) injury with regard to 3 ACL graft choices; the use of semitendinosus (ST), the use of semitendinosus-gracilis (ST-G), and the use of patellar tendon (PT) autograft. It was hypothesized that the use of ST-G would be associated with a greater risk of ACL revision and poorer patient-reported knee function.METHODS: Patients older than 15 years of age registered for a primary ACL reconstruction with a concomitant non-surgically treated MCL injury in the Swedish National Knee Ligament Registry were assessed for eligibility. Three groups were created according to ACL autograft choice; the ST, the ST-G, and the PT group. The primary outcomes were ACL revision and the 1- and 2-year Knee injury and Osteoarthritis Outcome Score (KOOS), including the KOOS patient acceptable symptom state (PASS). Cox regression analysis was applied to determine the proportional hazard ratio (HR) of primary ACL reconstruction survival. The KOOS was compared using the Mann-Whitney U test and Fisher exact test.RESULTS: A total of 622 patients (mean age 29.7 years, 42.4% women) were included. There was no difference in the risk of ACL revision for either the ST group (HR 1.354; 95% confidence interval [CI] 0.678-2.702 or the PT group (HR 0.837; 95% CI 0.334-2.100), compared with the ST-G group. The ST group reported a greater mean 2-year KOOS sports and recreation (68.5, standard deviation [SD] 28.5) than the ST-G group (57.4 [SD 27.6], P = .010) and the PT group (54.1 [SD 30.3], P = .006). The ST group was superior in terms of achieving PASS in sports and recreation (55.3%; 95% CI 44.1-66.1%) compared with both the ST-G (37.4%; 95% CI 29.8-45.5%; P = .014) and the PT group (33.9%; 95% CI 22.1-47.4%; P = .009).CONCLUSIONS: The risk of ACL revision did not differ between HT and PT autografts in patients undergoing ACL reconstruction with a non-surgically treated MCL injury. However, the use of ST-G was associated with poorer 2-year patient-reported knee function compared with the ST.LEVEL OF EVIDENCE: Retrospective comparative trial, Level III.

AB - PURPOSE: To compare the risk of anterior cruciate ligament (ACL) revision and the patient-reported outcome after ACL reconstruction with a concomitant non-surgically treated medial collateral ligament (MCL) injury with regard to 3 ACL graft choices; the use of semitendinosus (ST), the use of semitendinosus-gracilis (ST-G), and the use of patellar tendon (PT) autograft. It was hypothesized that the use of ST-G would be associated with a greater risk of ACL revision and poorer patient-reported knee function.METHODS: Patients older than 15 years of age registered for a primary ACL reconstruction with a concomitant non-surgically treated MCL injury in the Swedish National Knee Ligament Registry were assessed for eligibility. Three groups were created according to ACL autograft choice; the ST, the ST-G, and the PT group. The primary outcomes were ACL revision and the 1- and 2-year Knee injury and Osteoarthritis Outcome Score (KOOS), including the KOOS patient acceptable symptom state (PASS). Cox regression analysis was applied to determine the proportional hazard ratio (HR) of primary ACL reconstruction survival. The KOOS was compared using the Mann-Whitney U test and Fisher exact test.RESULTS: A total of 622 patients (mean age 29.7 years, 42.4% women) were included. There was no difference in the risk of ACL revision for either the ST group (HR 1.354; 95% confidence interval [CI] 0.678-2.702 or the PT group (HR 0.837; 95% CI 0.334-2.100), compared with the ST-G group. The ST group reported a greater mean 2-year KOOS sports and recreation (68.5, standard deviation [SD] 28.5) than the ST-G group (57.4 [SD 27.6], P = .010) and the PT group (54.1 [SD 30.3], P = .006). The ST group was superior in terms of achieving PASS in sports and recreation (55.3%; 95% CI 44.1-66.1%) compared with both the ST-G (37.4%; 95% CI 29.8-45.5%; P = .014) and the PT group (33.9%; 95% CI 22.1-47.4%; P = .009).CONCLUSIONS: The risk of ACL revision did not differ between HT and PT autografts in patients undergoing ACL reconstruction with a non-surgically treated MCL injury. However, the use of ST-G was associated with poorer 2-year patient-reported knee function compared with the ST.LEVEL OF EVIDENCE: Retrospective comparative trial, Level III.

U2 - 10.1016/j.arthro.2019.07.015

DO - 10.1016/j.arthro.2019.07.015

M3 - Article

C2 - 31526609

JO - Arthroscopy - Journal of Arthroscopic and Related Surgery

JF - Arthroscopy - Journal of Arthroscopic and Related Surgery

SN - 0749-8063

ER -