Study Seeks Answers to ACL Failures (written by Biloine Young @ OTW)
Here is the problem: More than 200,000 anterior cruciate ligament (ACL) surgeries are performed each year in the United States and from 1% to 8% fail. Most of the patients whose initial surgery failed then choose to have their knee ligaments reconstructed for a second time. Those second surgeries have a failure rate that is almost 14%.
Sports medicine specialists at Washington University School of Medicine in St. Louis are leading a national study analyzing why a second surgery to reconstruct a tear in the knee’s anterior cruciate ligament is so often unsuccessful.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases has awarded a $2.6 million grant to Washington University School of Medicine to conduct what is believed to be one of the largest orthopedic, multicenter studies ever conducted.
Rick W. Wright, professor of orthopedic surgery, co-chief of Washington University’s Sports Medicine Service and an orthopedic surgeon at Barnes-Jewish Hospital, has helped recruit 87 surgeons from 52 centers to participate in the Multicenter ACL Revision Study (MARS). All are sports medicine specialists who are members of the American Orthopaedic Society for Sports Medicine. Surgeons involved in the study include both academic physicians and those in private practice. They plan to enroll 1,000 patients at the various centers around the country and follow them for at least two years to identify predictors of problems after surgery.
The MARS study is comparing surgical techniques and analyzing outcomes to learn why a subsequent reconstruction is more likely to fail than an initial ACL repair. “In a previous study, we found that the strongest predictor for a bad outcome after ACL surgery was whether that surgery was the initial reconstruction or a subsequent procedure,” Wright said.
As part of the study surgeons will note the condition of the knee and how the original surgery was performed to see whether that predicts problems with a subsequent operation. They also will note the surgical technique initially used and whether the ACL graft used in the initial reconstruction came from a cadaver, from the hamstring muscle or from the patellar tendon.
Investigators will also compare rehabilitation techniques, whether particular approaches are related to better, or worse, outcomes, and assess the patients’ health and quality of life before and after a second ACL surgery. Those participating in the MARS study must be older than 12, but there is no upper age limit.
“By definition, most of the people in the study will be active,” Wright said. “Most are athletes who want to continue to compete, but the study also is open to those who just need knee surgery so they can get back to work.”