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Risk of Tearing the Intact Anterior Cruciate Ligament in the Contralateral Knee and Rupturing the Anterior Cruciate Ligament Graft During the First 2 Years After Anterior Cruciate Ligament Reconstruction

A Prospective MOON Cohort Study

Rick W. Wright, MD^,*, Warren R. Dunn, MD, Annunziato Amendola, MD, Jack T. Andrish, MD^||, John Bergfeld, MD^||, Christopher C. Kaeding, MD^¶, Robert G. Marx, MD^#, Eric C. McCarty, MD^**, Richard D. Parker, MD^||, Michelle Wolcott, MD^**, Brian R. Wolf, MD and Kurt P. Spindler, MD

From the Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri, Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee, Department of Orthopaedic Surgery, University of Iowa School of Medicine, Iowa City, Iowa, ^|| Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, ^¶ Department of Orthopaedic Surgery, The Ohio State University School of Medicine, Columbus, Ohio, ^# Sports Medicine Division, Hospital for Special Surgery, New York, New York, and the ^** Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, Colorado

^* Address correspondence to Rick W. Wright, MD, 1 Barnes-Jewish Hospital, Suite 11300, St. Louis, MO 63110 (e-mail: rwwright1{at}aol.com).

Background: The risk of tear of the intact anterior cruciate ligament in the contralateral knee after anterior cruciate ligament reconstruction of the opposite knee and the incidence of rupturing the anterior cruciate ligament graft during the first 2 years after surgery have not been extensively studied in a prospective manner. Clinicians have hypothesized that the opposite normal knee is at equal or increased risk compared with the risk of anterior cruciate ligament graft rupture in the operated knee.

Hypothesis: The risk of anterior cruciate ligament graft rupture and contralateral normal knee anterior cruciate ligament rupture at 2-year follow-up is equal.

Study Design: Cohort study; Level of evidence, 2.

Methods: The Multicenter Orthopaedic Outcome Network (MOON) database of a prospective longitudinal cohort of anterior cruciate ligament reconstructions was used to determine the number of anterior cruciate ligament graft ruptures and tears of the intact anterior cruciate ligament in the contralateral knee at 2-year follow-up. Two-year follow-up consisted of a phone interview and review of operative reports.

Results: Two-year data were obtained for 235 of 273 patients (86%). There were 14 ligament disruptions. Of these, 7 were tears of the intact anterior cruciate ligament in the contralateral knee (3.0%) and 7 were anterior cruciate ligament graft failures (3.0%).

Conclusion: The contralateral normal knee anterior cruciate ligament is at a similar risk of anterior cruciate ligament tear (3.0%) as the anterior cruciate ligament graft after primary anterior cruciate ligament reconstruction (3.0%).

Key Words: ACL • reconstruction • graft failure • contralateral

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