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This Article Full Text Full Text (PDF) All Versions of this Article: 32/8/1906    most recent 0363546504265006v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (5) Citing Articles via Google Scholar Google Scholar Articles by Dunn, W. R. Articles by Marx, R. G. Search for Related Content PubMed PubMed Citation Articles by Dunn, W. R. Articles by Marx, R. G. Related Collections Reconstruction Knee

The Effect of Anterior Cruciate Ligament Reconstruction on the Risk of Knee Reinjury

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^*,,¶

From the ^* Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, Foster Center for Clinical Outcome Research, Hospital for Special Surgery, New York, New York, War-Related Illness and Injury Study Center, Veterans Affairs Medical Center, Department of Veterans Affairs, Washington, DC, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and ^|| US Army Research Institute of Environmental Medicine, Natick, Massachusetts

^¶ Address correspondence to Robert G. Marx, MD, MSc, FRCSC, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021 (e-mail: marxr{at}hss.edu).

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.

Key Words: adult • anterior cruciate ligament (ACL) • injury • reinjury • reoperation • military • outcome study

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