Reducing Graft Failure and Reoperation After Anterior Cruciate Ligament Reconstruction in Professional Athletes Using a Systematic Surgical Approach: An Analysis of 342 Patients With a Mean Follow-up of 100 Months From the SANTI Study Group.

BACKGROUND

Anterior cruciate ligament (ACL) injuries are prevalent among elite athletes, particularly in high-impact sports. While ACL reconstruction (ACLR) is the gold-standard treatment, graft failure rates can exceed 30% in high-risk populations. Moreover, associated meniscal injuries often necessitate secondary surgical interventions. Implementing a systematic surgical approach, including advanced meniscal repair techniques and lateral extra-articular procedures, may enhance outcomes and reduce reoperation rates.

PURPOSE/HYPOTHESIS: This study aimed to assess the effect of a systematic approach to ACLR on secondary surgery rates and ACL graft survival among professional athletes. It was hypothesized that this approach would significantly reduce secondary surgeries and ACL graft failures.

STUDY

DESIGN

Cohort study; Level of evidence, 3.

METHODS

A retrospective analysis of data from the SANTI database, focusing on professional athletes who underwent primary ACLR performed by a single senior surgeon between 2003 and 2020, was performed. Patients were categorized into 2 groups: those before October 2012 and those treated after the introduction of a systematic surgical approach. Primary outcomes included ACL graft rupture rates and secondary surgery rates (meniscectomy and revision ACLR). Cox proportional hazards models were used to evaluate risk factors.

RESULTS

The final cohort comprised 342 patients, with 130 treated before October 2012 and 212 after the introduction of a systematic protocol. Athletes treated after October 2012 exhibited a significantly lower rate of secondary surgery (30.0% before vs 16.5% after, P = .0174) and reduced ACL graft rupture rates (13.1% before vs 6.6% after, P = .0039). The 7-year graft survival rate improved from 86.9% before October 2012 to 93.3% after that month. Notably, younger athletes (<21 years) had an elevated risk of reoperation (hazard ratio, 2.090) and graft failure (hazard ratio, 2.224). The systematic approach also led to a significant reduction in the rate of secondary medial meniscectomy (10.8% vs 3.3%, P = .0052).

CONCLUSION

A systematic approach to ACLR significantly reduced secondary surgeries and graft failure rates in elite athletes. These findings support the routine use of advanced meniscal repair techniques and lateral extra-articular procedures to enhance long-term outcomes.