Sports medicine specialists at Washington University School of Medicine are leading a national study analyzing why a second surgery to reconstruct a tear in the knee’s anterior cruciate ligament (ACL) carries a high risk of bad outcomes.
More than 200,000 ACL reconstruction surgeries are performed each year in the United States, and one to eight percent of them fail for some reason. Most of those patients then opt to have their knee ligament reconstructed a second time, but the failure rate on those subsequent surgeries is almost 14 percent.
The Multicenter ACL Revision Study (MARS) is comparing surgical techniques and analyzing outcomes for patients undergoing ACL surgery.
“If I reconstruct the ACL in your knee, and you go back to sports, and three years later you pivot on a basketball court and tear it again, that subsequent surgery often does not have results equal to the original surgery,” explains Rick Wright, MD, an orthopedic surgeon and the study’s principal investigator.
Wright and 87 other surgeons from 52 centers plan to enroll 1,000 patients and follow them for at least two years.
Surgeons will note the condition of the knee and how the original surgery was performed. They also will make note of 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.
They will compare rehabilitation techniques and whether particular approaches are related to better, or worse, outcomes. Patients also will be surveyed about knee function, the general state of their health and their quality of life before and after a second ACL surgery.
The ACL is key to the ability to cut, jump, twist and change directions. ACL tears are related to having a knee give out, and that, says Wright, can damage the meniscus, the rubbery disc that cushions the knee. It also can tear cartilage, contribute to arthritis and increase the risk that an individual will someday require total knee replacement surgery.