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Association of the Graft Size and Arthrofibrosis in Young Patients After Primary Anterior Cruciate Ligament Reconstruction

Su, Alvin W., MD, PhD; Storey, Eileen P., BA; Lin, Shuai-Chun, MD; Forst, Benjamin, PA-C; Lawrence, J. Todd, MD, PhD; Ganley, Theodore J., MD; Wells, Lawrence, MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: December 1, 2018 - Volume 26 - Issue 23 - p e483–e489
doi: 10.5435/JAAOS-D-17-00177
Research Article

Introduction: This study investigated the association of graft-related surgical factors and patient characteristics with the odds of arthrofibrosis after primary anterior cruciate ligament reconstruction (ACL-R).

Methods: A retrospective case-control study assessed consecutive patients who underwent primary ACL-R in one tertiary pediatric hospital. Each arthrofibrosis case was matched to three controls for sex, calendar year, and age at the time of ACL-R, as well as the primary surgeon. Conditional multivariable logistic regression assessed the independent association of graft diameter, time from injury to ACL-R, concomitant knee pathologies, and body mass index.

Results: Twenty arthrofibrosis cases of 1,121 ACL-R patients (incidence 1.8%) were matched to 60 controls resulting in the mean age of 14.5 years. An increase of 1 mm graft diameter was associated with 3.2-times increased odds of arthrofibrosis. Other variables were not independently associated with arthrofibrosis.

Conclusion: For young patients, the decision on the graft size must consider the possibility of arthrofibrosis with a larger graft versus reinjury with a smaller graft.

From the Department of Orthopaedic Surgery (Dr. Su, Dr. Lawrence, Dr. Ganley, and Dr. Wells), University of Pennsylvania, Children's Hospital of Philadelphia, Children's Hospital of Philadelphia (Dr. Storey and Dr. Forst), and National Yang-Ming University (Dr. Lin), Taipei, Taiwan.

Correspondence to Dr. Wells:

Dr. Lawrence or an immediate family member has received royalties from Sawbones/Pacific Research Laboratories, is a member of a speakers' bureau or has made paid presentations on behalf of Arthrex, and has stock or stock options held in Practice Medical Instruments. Dr. Ganley or an immediate family member has received research or institutional support from AlloSource and Vericel; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research-related funding (such as paid travel) from Arthrex; serves as a board member, owner, officer, or committee member of the International Pediatric Orthopaedic Symposium, Pediatric Research in Sports Medicine; the Philadelphia Orthopaedic Society, and Research on Osteochondritis Dissecans of the Knee. Dr. Wells or an immediate family member serves as a board member, owner, officer, or committee member of the Philadelphia Orthopaedic Society. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Su, Ms. Storey, Dr. Lin, and Mr. Forst.

This study was approved by the institutional IRB# 15-012614.

© 2018 by American Academy of Orthopaedic Surgeons
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