Survival of the Anterior Cruciate Ligament Graft and the Contralateral ACL at a Minimum of 15 Years

Abstract

Background: The risks for primary anterior cruciate ligament (ACL) rupture have been established. What is less well known is the risk of graft rupture after reconstruction and also the risk of a primary ACL rupture in the contralateral knee. Purpose: To determine the long-term survival of the ACL graft and the contralateral ACL (CACL) after reconstruction and to identify factors that increase the odds of subsequent ACL injury. Study Design: Case series; Level of evidence, 4. Methods: All patients having undergone primary ACL reconstruction in 1993 or 1994 by a single surgeon in a single unit were considered. Patients were contacted to complete a subjective interview by telephone or e-mail questionnaire at a minimum of 15 years after surgery. Results: A total of 755 patients met the inclusion criteria, and ACL reconstruction was performed using a single-incision endoscopic technique with either autologous bone–patellar tendon–bone graft (BPTB; n = 314) or hamstring tendon graft (HT; n = 359) and metal interference screw fixation. Of these patients, 673 (89%) completed the questionnaire; 23% had sustained either a graft rupture or CACL rupture. Expected survival of the ACL graft was 95%, 93%, 91%, and 89% at a respective 2, 5, 10, and 15 years after reconstruction. Expected survival of the CACL was 97%, 93%, 90%, and 87%, respectively. Survival of the ACL graft was less favorable in men than in women ( P = .007); ACL graft survival was not significantly different between the HT (88%) or BPTB (91%) groups ( P = .149). Rupture of the CACL occurred twice as frequently as graft rupture in the BPTB group (graft survival, 84% vs 89%; P = .003). A positive family history of ACL rupture doubled the odds of both ACL graft and CACL rupture. The mean International Knee Documentation Committee subjective score at 15 years was 85. Return to preinjury sport levels was reported in 73% of patients, and 51% were still participating in strenuous or very strenuous activities at 15 years. Conclusion: Fifteen years after ACL reconstruction, expected survival of the ACL graft was 89% and expected survival of the CACL was 86%. Graft choice did not affect ACL graft rupture, but using BPTB increased the risk of CACL rupture compared with HT. Men had a less favorable survival rate of the ACL graft than did women, and a family history of ACL rupture increased the risk of both ACL graft and CACL rupture.