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Primary Anterolateral Ligament Rupture in Patients Requiring Revision Anterior Cruciate Ligament Reconstruction: A Retrospective Magnetic Resonance Imaging Review.

Arthroscopy 2018 October 7
PURPOSE: To compare the initial rate of anterolateral ligament (ALL) injury at the time of anterior cruciate ligament (ACL) rupture in patients who subsequently experienced ACL reconstruction graft failure versus patients who did not experience subsequent ACL reconstruction graft failure.

METHODS: Our institution's electronic medical record database was queried for patients who underwent primary ACL reconstruction and then experienced subsequent ACL graft rupture. Patients were included only if they presented acutely (<3 months from time of injury) and had an isolated ACL rupture with no other cruciate or collateral ligamentous injury. Exclusion criteria included lack of an available magnetic resonance imaging (MRI) scan, ACL injury greater than 3 months, previous ACL reconstruction, and age younger than 13 or older than 50 years. Each patient was paired with an age-, gender-, and graft-matched control who underwent ACL reconstruction without subsequent graft rupture. Each patient was diagnosed with an intact, partially injured, or fully ruptured ALL on initial injury MRI. The location of ALL injury was also noted. The incidence of ALL rupture and location of rupture between the 2 groups was compared using χ-square analysis.

RESULTS: There were 1,967 patients who underwent primary ACL reconstruction; 128 patients experienced ACL graft rupture, and 55 patients (43%) had MRI scans available for review. Of these patients, 39 fulfilled the inclusion criteria with available MRI and were matched with a control patient. In the revision ACL reconstruction group, the ALL was diagnosed as intact, partially torn, and completely torn in 17, 14, and 8 patients, respectively. In the control group, the ALL was diagnosed as intact, partially torn, and completely torn in 18, 13, and 8 patients, respectively. Pearson χ-square test revealed no difference between the groups in frequency of ALL rupture (Pearson χ-square = 0.066; P = .968). There was also no difference in the location of ALL rupture between the 2 groups, although the revision group had a higher trend of tibial-sided injuries.

CONCLUSIONS: The incidence of initial ALL injury as documented on MRI was not different in patients who experienced subsequent ACL graft rupture compared with patients who did not experience ACL graft rupture after primary ACL reconstruction. The ALL was more commonly injured on the tibial side in patients with ACL graft rupture and femoral-sided lesions were more common in control patients.

LEVEL OF EVIDENCE: Level III, prognostic case-control study.

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