Risk factors for postoperative graft laxity without re-injury after double-bundle anterior cruciate ligament reconstruction in recreational athletes.

Abstract

BACKGROUND\nAlthough high activity is a risk factor for graft failure after anterior cruciate ligament (ACL) reconstruction, the risk factors for postoperative laxity after ACL reconstruction in recreational athletes are unknown.\n\n\nMETHODS\nWe enrolled 91 patients (40 males, 51 females; mean age 29.2\xa0years; mean follow-up 4.3\xa0years) who scored\xa0≤\xa06 on the Tegner activity scale, underwent double-bundle ACL reconstruction between 2010 and 2018, and did not experience re-injury. In the stable group (75 patients, <3.0\xa0mm side-to-side difference (SSD) in anterior translation, grade 0 or 1 pivot shift 1\xa0year after surgery) and unstable group (16 patients, ≥3.0\xa0mm SSD, ≥grade 2 pivot shift), multivariate logistic regression analyses adjusted for factors showing P\xa0≤\xa00.3 on univariate analysis assessed risk factors for graft laxity. Lysholm score and graft intensity on MRI (Howell grade) were compared at final follow-up.\n\n\nRESULTS\nMean SSD in anterior translation was 0.7\xa0mm (stable group) and 3.3\xa0mm (unstable group). Pivot shift grades were 0 (88%) and 1 (12%) in the stable group, and 0 (12.5%), 1 (50%), and 2 (37.5%) in the unstable group. Multivariate regression analyses showed that younger age and knee hyperextension were significant risk factors for graft laxity (P\xa0=\xa00.018 and 0.0016; cutoffs 18\xa0years old and 8°, respectively). Lysholm scores in both groups were comparable, but graft intensity on MRI demonstrated significantly worse Howell grade in the unstable group (P\xa0=\xa00.002).\n\n\nCONCLUSION\nYounger age and knee hyperextension were risk factors for postoperative graft laxity without re-injury in recreational athletes.