Predictors for graft rupture after anterior cruciate reconstruction: a study of 731 cases with a mean follow-up of 5.5 years (Award Paper Session)

Abstract

<p><strong>Introduction:</strong> This study aims to determine the predictors for postoperative graft rupture after primary anterior cruciate ligament reconstruction (ACLR).</p><p><strong>Methods:</strong> Pre-, intra-, and postoperative data of patients who underwent primary ACLR between 2007 and 2021 were collected prospectively and retrospectively using a standard form. The posterior tibial slope, medial proximal tibial angle, and the position of the tibial tunnel were measured using knee radiographs. The graft bending angle (GBA) and the size of the intercondylar notch were measured using computed tomography. The primary outcome was graft rupture diagnosed by magnetic resonance imaging or repeat arthroscopy. Multiple linear regression with a stepwise algorithm was performed to identify predictors for graft rupture after ACLR.</p><p><strong>Results: </strong>The mean age of 606 male and 125 female patients was 28±8 years. The mean follow-up duration was 66±52 months. In total, 59 (8%) graft ruptures occurred at a mean of 55±44 months. The predictors for graft rupture, in decreasing importance, were time elapsed since ACLR (p<0.001), femoral GBA in the sagittal plane (p<0.001), age (p=0.001), International Knee Documentation Committee activity level at final follow-up (p=0.09), and posterior tibial slope (p=0.01).</p><p><strong>Conclusion:</strong> The only modifiable surgical factor that may help reduce graft rupture after ACLR is the femoral GBA in the sagittal plane</p>