Younger age, hyperextended knee, concomitant meniscectomy and large prerevision anterior tibial translation are associated with graft failure after the revision anterior cruciate ligament reconstruction

Purpose: Graft failure following revision anterior cruciate ligament (ACL) reconstruction is higher than after primary ACL reconstruction. However, data regarding revision surgery is scarce. We aimed to evaluate the associated factors for failure after revision ACL reconstruction. Methods: Fifty-four patients (mean age: 24.7 +/- 10.0 years) who underwent revision ACL reconstruction at our hospital with >= 1 year follow-up were retrospectively examined. Patients were divided into Group F (graft failure) and Group N (no graft failure) groups. Univariate analysis was conducted to identify factors associated with graft failure. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal thresholds for differentiating between the two groups. Results: Graft failure was observed in 7 of 54 patients (13.0%). In the univariate analysis, significant differences were observed for age at the initial surgery (Group F: 15.6 +/- 1.5, Group N: 20.9 +/- 8.1), age at the revision surgery (Group F: 18.0 +/- 2.8, Group N: 25.7 +/- 10.3), presence of hyperextended knee (Group F: 85.7%, Group N: 14.9%), concomitant meniscectomy (Group F: 42.9%, Group N: 14.9%), prerevision space for the ACL (sACL) (Group F: 7.2 +/- 3.4 mm, Group N: 13.4 +/- 4.7 mm) and preoperative anterior tibial translation (ATT) (Group F: 5.0 +/- 1.4 mm, Group N: 2.7 +/- 3.1 m). ROC analysis of preoperative sACL and preoperative ATT on one-leg standing plain radiograph showed that cutoff values of 6.9 and 4.2 mm were the optimal thresholds, respectively. Conclusion: Younger patients with a hyperextended knee, concomitant meniscectomy, small sACL and large ATT before revision ACL reconstruction are predisposed to graft failure.