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Article Title

LONG-TERM RATE OF GRAFT FAILURE AFTER ACL RECONSTRUCTION: A GEOGRAPHIC POPULATION COHORT ANALYSIS

Abstract

Graft failure following anterior cruciate ligament reconstruction (ACLR) is a devastating injury among patients returning to activity. PURPOSE: The goals of this study are to define the long-term rate of graft failure after ACLR in the general population and evaluate factors associated with ACL graft failure. METHODS: This long-term observational study included a population-based incidence cohort of patients who underwent primary ACLR after diagnosis with new-onset, isolated ACL tears between 1990 and 2010. For all patients, a chart review was performed to collect information related to the initial injury, treatment, and outcomes. Patients were retrospectively followed to determine the incidence of graft failure following ACLR. RESULTS: The study cohort consisted of 1,355 patients with new-onset, isolated ACL tears treated with ACLR. At a mean follow-up of 10.0 years (±6.4 years) following ACLR, a total of 72 patients (5.3%) sustained ipsilateral graft failure. The graft survival following ACLR was 99.7% at 1 year, 96% at 5 years, 94% at 10 years, 93% at 15 years, 92% at 20 years, and 91% at 25 years. Among patients 22 years or younger (n = 571), the rate of graft failure was significantly higher compared to patients older than 22 years (6.3% vs 4.6%, p = 0.04). The rate of graft failure decreased significantly over the 21-year observation period of this study (p < 0.0001). CONCLUSION: Among all patients receiving primary ACLR, graft failure remains an uncommon but functionally devastating outcome with an estimated graft survival rate of 91% at 25 years following surgery. Patients aged 22 or younger had a significantly higher rate of graft failure than older patients. The rate of graft failure decreased over the 21-year span of this study.

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