Risk Factors for Early Subsequent (Revision or Contralateral) ACL Reconstruction: A Retrospective Database Study

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biostatistics

Background:

• Subsequent anterior cruciate ligament reconstruction (ACLR) risk factors are multifactorial.
• Understanding early revision or contralateral ACLR incidence is crucial for patient management.

Purpose of the Study:

• To determine the incidence of subsequent ACLR within two years in a large patient cohort.
• To explore patient-specific risk factors associated with early subsequent ACLR, stratified by age group.

Main Methods:

• Retrospective review of the California Office of Statewide Health Planning and Development Ambulatory Surgery Database (2005-2014).
• Case-control study design (Level of evidence, 3) analyzing 94,108 patients.
• Identification of risk factors for subsequent ACLR based on age, race, and insurance status.

Main Results:

• Subsequent ACLR rates were highest in patients under 21 years (2.4 per 100 person-years) and lowest in those over 40 years (1.3 per 100 person-years).
• Younger age, white race, private insurance (for <21 years), and public insurance/workers' compensation (for >30 years) were associated with increased risk.
• Significant associations between patient demographics and insurance and subsequent ACLR risk were observed across age groups.

Conclusions:

• Findings offer insights into subsequent ACL reconstruction, aiding in risk assessment and treatment modification for at-risk patients.
• Highlights the importance of data mining in national and international databases for generating clinically applicable research in orthopedic surgery.
• Age and specific demographic factors significantly influence the risk of requiring revision or contralateral ACLR.