Effect of Tibiofemoral Rotation Angle on Graft Failure After Anterior Cruciate Ligament Reconstruction
Background: Coronal and sagittal malalignment of the knee are well-recognized risk factors for failure after anterior cruciate ligament (ACL) reconstruction (ACLR). However, the effect of axial malalignment on graft survival after ACLR is yet to be determined. Purpose: To evaluate whether increased...
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| Veröffentlicht in: | The American journal of sports medicine 2023-07, Vol.51 (9), p.2291-2299 |
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| creator | Leite, Chilan Bou Ghosson Merkely, Gergo Farina, Evan M. Smith, Richard Görtz, Simon Hazzard, Sean Asnis, Peter Lattermann, Christian |
| description | Background:
Coronal and sagittal malalignment of the knee are well-recognized risk factors for failure after anterior cruciate ligament (ACL) reconstruction (ACLR). However, the effect of axial malalignment on graft survival after ACLR is yet to be determined.
Purpose:
To evaluate whether increased tibiofemoral rotational malalignment, namely, tibiofemoral rotation angle (TFA) and tibial tubercle–trochlear groove (TT-TG) distance, is associated with graft failure after ACLR.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
In this retrospective matched control study of a single center’s database, 151 patients who underwent revision ACLR because of graft failure (ACLR failure group, defined as symptomatic patients with anterior knee instability and an ACL graft tear appreciated on magnetic resonance imaging [MRI] and confirmed during arthroscopic surgery) were compared with a matched control group of 151 patients who underwent primary ACLR with no evidence of failure after ≥2-year follow-up (intact ACLR group). Patients were matched by sex, age, and meniscal injury during primary ACLR. Axial malalignment was assessed on preoperative MRI through the TFA and the TT-TG distance. Sagittal alignment was measured through the posterior tibial slope on MRI. The optimal TFA cutoff associated with graft failure was identified by a receiver operating characteristic curve. The Kaplan-Meier curve with log-rank analysis was performed to evaluate the influence of the TFA on ACLR longevity.
Results:
The mean age was 25.7 ± 10.4 years for the ACLR failure group and 25.9 ± 10.0 years for the intact ACLR group. Among all the included patients, 174 (57.6%) were male. In the ACLR failure group, the mean TFA was 5.8°± 4.5° (range, −5° to 16°), while it was 3.0°± 3.3° (range, −3° to 15°) in the intact ACLR group (P < .001). Neither the TT-TG distance nor the posterior tibial slope presented statistical differences between the groups. The receiver operating characteristic curve suggested an optimal TFA cutoff of 4.5° for graft failure (area under the curve = 0.71; P < .001; sensitivity, 68.2%; specificity, 75.5%). Considering this a threshold, patients who had a TFA ≥4.5° had 6.6 times higher odds of graft failure compared with patients with a TFA |
| doi_str_mv | 10.1177/03635465231163856 |
| format | Article |
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Coronal and sagittal malalignment of the knee are well-recognized risk factors for failure after anterior cruciate ligament (ACL) reconstruction (ACLR). However, the effect of axial malalignment on graft survival after ACLR is yet to be determined.
Purpose:
To evaluate whether increased tibiofemoral rotational malalignment, namely, tibiofemoral rotation angle (TFA) and tibial tubercle–trochlear groove (TT-TG) distance, is associated with graft failure after ACLR.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
In this retrospective matched control study of a single center’s database, 151 patients who underwent revision ACLR because of graft failure (ACLR failure group, defined as symptomatic patients with anterior knee instability and an ACL graft tear appreciated on magnetic resonance imaging [MRI] and confirmed during arthroscopic surgery) were compared with a matched control group of 151 patients who underwent primary ACLR with no evidence of failure after ≥2-year follow-up (intact ACLR group). Patients were matched by sex, age, and meniscal injury during primary ACLR. Axial malalignment was assessed on preoperative MRI through the TFA and the TT-TG distance. Sagittal alignment was measured through the posterior tibial slope on MRI. The optimal TFA cutoff associated with graft failure was identified by a receiver operating characteristic curve. The Kaplan-Meier curve with log-rank analysis was performed to evaluate the influence of the TFA on ACLR longevity.
Results:
The mean age was 25.7 ± 10.4 years for the ACLR failure group and 25.9 ± 10.0 years for the intact ACLR group. Among all the included patients, 174 (57.6%) were male. In the ACLR failure group, the mean TFA was 5.8°± 4.5° (range, −5° to 16°), while it was 3.0°± 3.3° (range, −3° to 15°) in the intact ACLR group (P < .001). Neither the TT-TG distance nor the posterior tibial slope presented statistical differences between the groups. The receiver operating characteristic curve suggested an optimal TFA cutoff of 4.5° for graft failure (area under the curve = 0.71; P < .001; sensitivity, 68.2%; specificity, 75.5%). Considering this a threshold, patients who had a TFA ≥4.5° had 6.6 times higher odds of graft failure compared with patients with a TFA <4.5° (P < .001). Survival analysis demonstrated a 5-year survival rate of 81% in patients with a TFA <4.5°, while it was 44% in those with a TFA ≥4.5° (P < .001).
Conclusion:
An increased TFA was associated with increased odds of ACLR failure when the TFA was ≥4.5°. Measuring the TFA in patients with ACL tears undergoing reconstruction may inform the surgeon about additional factors that may require consideration before ACLR for a successful outcome.]]></description><identifier>ISSN: 0363-5465</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/03635465231163856</identifier><identifier>PMID: 37454271</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adolescent ; Adult ; Anterior Cruciate Ligament Injuries - surgery ; Anterior Cruciate Ligament Reconstruction - adverse effects ; Anterior Cruciate Ligament Reconstruction - methods ; Cohort Studies ; Female ; Humans ; Knee Joint - diagnostic imaging ; Knee Joint - pathology ; Knee Joint - surgery ; Magnetic resonance imaging ; Male ; Retrospective Studies ; Rotation ; Sports medicine ; Survival analysis ; Young Adult</subject><ispartof>The American journal of sports medicine, 2023-07, Vol.51 (9), p.2291-2299</ispartof><rights>2023 The Author(s)</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-3841b8f125a861f20090d7ad20fe7e6df8e7bc1fe6a4548be402de02474e4b103</citedby><cites>FETCH-LOGICAL-c368t-3841b8f125a861f20090d7ad20fe7e6df8e7bc1fe6a4548be402de02474e4b103</cites><orcidid>0000-0001-6660-6994 ; 0000-0002-8386-3121</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/03635465231163856$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/03635465231163856$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,777,781,21800,27905,27906,43602,43603</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37454271$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Leite, Chilan Bou Ghosson</creatorcontrib><creatorcontrib>Merkely, Gergo</creatorcontrib><creatorcontrib>Farina, Evan M.</creatorcontrib><creatorcontrib>Smith, Richard</creatorcontrib><creatorcontrib>Görtz, Simon</creatorcontrib><creatorcontrib>Hazzard, Sean</creatorcontrib><creatorcontrib>Asnis, Peter</creatorcontrib><creatorcontrib>Lattermann, Christian</creatorcontrib><title>Effect of Tibiofemoral Rotation Angle on Graft Failure After Anterior Cruciate Ligament Reconstruction</title><title>The American journal of sports medicine</title><addtitle>Am J Sports Med</addtitle><description><![CDATA[Background:
Coronal and sagittal malalignment of the knee are well-recognized risk factors for failure after anterior cruciate ligament (ACL) reconstruction (ACLR). However, the effect of axial malalignment on graft survival after ACLR is yet to be determined.
Purpose:
To evaluate whether increased tibiofemoral rotational malalignment, namely, tibiofemoral rotation angle (TFA) and tibial tubercle–trochlear groove (TT-TG) distance, is associated with graft failure after ACLR.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
In this retrospective matched control study of a single center’s database, 151 patients who underwent revision ACLR because of graft failure (ACLR failure group, defined as symptomatic patients with anterior knee instability and an ACL graft tear appreciated on magnetic resonance imaging [MRI] and confirmed during arthroscopic surgery) were compared with a matched control group of 151 patients who underwent primary ACLR with no evidence of failure after ≥2-year follow-up (intact ACLR group). Patients were matched by sex, age, and meniscal injury during primary ACLR. Axial malalignment was assessed on preoperative MRI through the TFA and the TT-TG distance. Sagittal alignment was measured through the posterior tibial slope on MRI. The optimal TFA cutoff associated with graft failure was identified by a receiver operating characteristic curve. The Kaplan-Meier curve with log-rank analysis was performed to evaluate the influence of the TFA on ACLR longevity.
Results:
The mean age was 25.7 ± 10.4 years for the ACLR failure group and 25.9 ± 10.0 years for the intact ACLR group. Among all the included patients, 174 (57.6%) were male. In the ACLR failure group, the mean TFA was 5.8°± 4.5° (range, −5° to 16°), while it was 3.0°± 3.3° (range, −3° to 15°) in the intact ACLR group (P < .001). Neither the TT-TG distance nor the posterior tibial slope presented statistical differences between the groups. The receiver operating characteristic curve suggested an optimal TFA cutoff of 4.5° for graft failure (area under the curve = 0.71; P < .001; sensitivity, 68.2%; specificity, 75.5%). Considering this a threshold, patients who had a TFA ≥4.5° had 6.6 times higher odds of graft failure compared with patients with a TFA <4.5° (P < .001). Survival analysis demonstrated a 5-year survival rate of 81% in patients with a TFA <4.5°, while it was 44% in those with a TFA ≥4.5° (P < .001).
Conclusion:
An increased TFA was associated with increased odds of ACLR failure when the TFA was ≥4.5°. Measuring the TFA in patients with ACL tears undergoing reconstruction may inform the surgeon about additional factors that may require consideration before ACLR for a successful outcome.]]></description><subject>Adolescent</subject><subject>Adult</subject><subject>Anterior Cruciate Ligament Injuries - surgery</subject><subject>Anterior Cruciate Ligament Reconstruction - adverse effects</subject><subject>Anterior Cruciate Ligament Reconstruction - methods</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Knee Joint - diagnostic imaging</subject><subject>Knee Joint - pathology</subject><subject>Knee Joint - surgery</subject><subject>Magnetic resonance imaging</subject><subject>Male</subject><subject>Retrospective Studies</subject><subject>Rotation</subject><subject>Sports medicine</subject><subject>Survival analysis</subject><subject>Young Adult</subject><issn>0363-5465</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1PIzEMhiO0iHaBH8BlFWkvXIbNd9JjVQGLVGklBOdRZsapUs1MuknmwL_flBaQWHFxLPvxaztG6IqSG0q1_kW44lIoyTilihupTtCcSskqzpX8hub7fLUHZuh7SltCCNXKnKEZ10IKpukcuVvnoM04OPzkGx8cDCHaHj-GbLMPI16Omx5wce6jdRnfWd9PEfDSZYglWawPEa_i1HqbAa_9xg4wZvwIbRhTLvG9zAU6dbZPcHl8z9Hz3e3T6ne1_nP_sFquq5YrkytuBG2Mo0xao6hjhCxIp23HiAMNqnMGdNNSB8qWBUwDgrAOCBNagGgo4efo-qC7i-HvBCnXg08t9L0dIUypZoYbJvhC84L-_IRuwxTHMt0rRRdaLlih6IFqY0gpgqt30Q82vtSU1Psj1P8dodT8OCpPzQDde8Xbrxfg5gAku4GPtl8r_gOh0I41</recordid><startdate>202307</startdate><enddate>202307</enddate><creator>Leite, Chilan Bou Ghosson</creator><creator>Merkely, Gergo</creator><creator>Farina, Evan M.</creator><creator>Smith, Richard</creator><creator>Görtz, Simon</creator><creator>Hazzard, Sean</creator><creator>Asnis, Peter</creator><creator>Lattermann, Christian</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6660-6994</orcidid><orcidid>https://orcid.org/0000-0002-8386-3121</orcidid></search><sort><creationdate>202307</creationdate><title>Effect of Tibiofemoral Rotation Angle on Graft Failure After Anterior Cruciate Ligament Reconstruction</title><author>Leite, Chilan Bou Ghosson ; Merkely, Gergo ; Farina, Evan M. ; Smith, Richard ; Görtz, Simon ; Hazzard, Sean ; Asnis, Peter ; Lattermann, Christian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-3841b8f125a861f20090d7ad20fe7e6df8e7bc1fe6a4548be402de02474e4b103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Anterior Cruciate Ligament Injuries - surgery</topic><topic>Anterior Cruciate Ligament Reconstruction - adverse effects</topic><topic>Anterior Cruciate Ligament Reconstruction - methods</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Knee Joint - diagnostic imaging</topic><topic>Knee Joint - pathology</topic><topic>Knee Joint - surgery</topic><topic>Magnetic resonance imaging</topic><topic>Male</topic><topic>Retrospective Studies</topic><topic>Rotation</topic><topic>Sports medicine</topic><topic>Survival analysis</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Leite, Chilan Bou Ghosson</creatorcontrib><creatorcontrib>Merkely, Gergo</creatorcontrib><creatorcontrib>Farina, Evan M.</creatorcontrib><creatorcontrib>Smith, Richard</creatorcontrib><creatorcontrib>Görtz, Simon</creatorcontrib><creatorcontrib>Hazzard, Sean</creatorcontrib><creatorcontrib>Asnis, Peter</creatorcontrib><creatorcontrib>Lattermann, Christian</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Leite, Chilan Bou Ghosson</au><au>Merkely, Gergo</au><au>Farina, Evan M.</au><au>Smith, Richard</au><au>Görtz, Simon</au><au>Hazzard, Sean</au><au>Asnis, Peter</au><au>Lattermann, Christian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Tibiofemoral Rotation Angle on Graft Failure After Anterior Cruciate Ligament Reconstruction</atitle><jtitle>The American journal of sports medicine</jtitle><addtitle>Am J Sports Med</addtitle><date>2023-07</date><risdate>2023</risdate><volume>51</volume><issue>9</issue><spage>2291</spage><epage>2299</epage><pages>2291-2299</pages><issn>0363-5465</issn><eissn>1552-3365</eissn><abstract><![CDATA[Background:
Coronal and sagittal malalignment of the knee are well-recognized risk factors for failure after anterior cruciate ligament (ACL) reconstruction (ACLR). However, the effect of axial malalignment on graft survival after ACLR is yet to be determined.
Purpose:
To evaluate whether increased tibiofemoral rotational malalignment, namely, tibiofemoral rotation angle (TFA) and tibial tubercle–trochlear groove (TT-TG) distance, is associated with graft failure after ACLR.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
In this retrospective matched control study of a single center’s database, 151 patients who underwent revision ACLR because of graft failure (ACLR failure group, defined as symptomatic patients with anterior knee instability and an ACL graft tear appreciated on magnetic resonance imaging [MRI] and confirmed during arthroscopic surgery) were compared with a matched control group of 151 patients who underwent primary ACLR with no evidence of failure after ≥2-year follow-up (intact ACLR group). Patients were matched by sex, age, and meniscal injury during primary ACLR. Axial malalignment was assessed on preoperative MRI through the TFA and the TT-TG distance. Sagittal alignment was measured through the posterior tibial slope on MRI. The optimal TFA cutoff associated with graft failure was identified by a receiver operating characteristic curve. The Kaplan-Meier curve with log-rank analysis was performed to evaluate the influence of the TFA on ACLR longevity.
Results:
The mean age was 25.7 ± 10.4 years for the ACLR failure group and 25.9 ± 10.0 years for the intact ACLR group. Among all the included patients, 174 (57.6%) were male. In the ACLR failure group, the mean TFA was 5.8°± 4.5° (range, −5° to 16°), while it was 3.0°± 3.3° (range, −3° to 15°) in the intact ACLR group (P < .001). Neither the TT-TG distance nor the posterior tibial slope presented statistical differences between the groups. The receiver operating characteristic curve suggested an optimal TFA cutoff of 4.5° for graft failure (area under the curve = 0.71; P < .001; sensitivity, 68.2%; specificity, 75.5%). Considering this a threshold, patients who had a TFA ≥4.5° had 6.6 times higher odds of graft failure compared with patients with a TFA <4.5° (P < .001). Survival analysis demonstrated a 5-year survival rate of 81% in patients with a TFA <4.5°, while it was 44% in those with a TFA ≥4.5° (P < .001).
Conclusion:
An increased TFA was associated with increased odds of ACLR failure when the TFA was ≥4.5°. Measuring the TFA in patients with ACL tears undergoing reconstruction may inform the surgeon about additional factors that may require consideration before ACLR for a successful outcome.]]></abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>37454271</pmid><doi>10.1177/03635465231163856</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-6660-6994</orcidid><orcidid>https://orcid.org/0000-0002-8386-3121</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0363-5465 |
| ispartof | The American journal of sports medicine, 2023-07, Vol.51 (9), p.2291-2299 |
| issn | 0363-5465 1552-3365 |
| language | eng |
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| source | MEDLINE; SAGE Complete A-Z List; Alma/SFX Local Collection |
| subjects | Adolescent Adult Anterior Cruciate Ligament Injuries - surgery Anterior Cruciate Ligament Reconstruction - adverse effects Anterior Cruciate Ligament Reconstruction - methods Cohort Studies Female Humans Knee Joint - diagnostic imaging Knee Joint - pathology Knee Joint - surgery Magnetic resonance imaging Male Retrospective Studies Rotation Sports medicine Survival analysis Young Adult |
| title | Effect of Tibiofemoral Rotation Angle on Graft Failure After Anterior Cruciate Ligament Reconstruction |
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