Predictors of Poor Outcome Following ACL Reconstruction With or Without Lateral Extra-articular Tenodesis : The STABILITY Trial

2019 CASEM Poster Presentation Predictors of Poor Outcome Following ACL Reconstruction With or Without Lateral Extraarticular Tenodesis: The STABILITY Trial D.Bryant,*,†A.Getgood,*,‡R.Litchfield,*,‡R.McCormack,§,{ D. Boyer,§,{ M. Heard,‖,** and P. MacDonald,††,‡‡ STABILITY Study Group Affiliations: *Fowler Kennedy Sport Medicine Clinic; †School of Physical Therapy, Western University; ‡Department of Surgery, Schulich School of Medicine and Dentistry, Western University; §Department of Orthopedics, University of British Columbia; {New West Orthopaedic & SportsMedicine Centre; ‖Deparment of Surgery, University of Calgary; **Banff Sport Medicine; ††Department of Surgery, University of Manitoba; and ‡‡Pan Am Clinic. Objective: To investigate which morphological and physical factors predict failure post ACL Reconstruction (ACLR). Design: Multicenter randomized clinical trial. Intervention: Logistic regression to determine variables that influence outcome within patients entered into a randomized clinical trial comparing ACLR with or without lateral extraarticular tenodesis (LET). Outcome Measures: A regression analysis was performed to determine which factors would be most predictive of graft failure. The primary outcome (combined graft failure 1 persistent rotatory laxity, measured by an asymmetric pivot shift) was the dependent variable with the following independent variables: (1) sex, (2) treatment group, (3) age at surgery, (4)medialmeniscus status, (5) lateral meniscus status, (6) Beighton score, (7) presence of knee hyper-extension, and (8) pivot shift under anesthesia. Results: Six hundred twenty-four patients, 293 male, were randomized with a mean age of 18.9 (range, 14-25). At 2 years post-operative, 104/252 (41%) of ACLR alone patients suffered the primary outcome compared to 61/252 (25%)of theACLR1 LETpatients. Thirty-nine patients had suffered graft rupture, 28/ 252 (11%) in the ACLR group compared to 11/242 (4.5%) in the ACL1 LET group. The most significant predictor of failure was the group allocation that is ACLR alone or ACLR 1 LET, with ACLRalone having an odds of failure about 2 times greater than those who got the LET (OR, 2.1; 95% CI, 1.4-3.0; P , 0.001). After controlling for group, for every year of age, the odds of failure was reduced by just over 5% (OR, 0.94; 95%CI, 0.93-0.96; P, 0.001). Compared to having no medial meniscal pathology, the odds of failure if there is a partial excision is more than 2 times greater (OR, 2.2; 95% CI, 1.2-4.3, P5 0.01). Sex, pivot shift grade, lateral meniscal status, Beighton score, and knee hyper-extension were not significant predictors of failure. When graft failurewas used as the dependent variable, treatment group and age remained significant predictors of outcome. Conclusions: In young patients, not performing a LET at the time of ACLR, status of the medial meniscus and younger age at the time of surgery are significant predictors of poor outcome when performing a hamstring tendon autograft, single bindle ACLR. Evaluating the Influence of Body Checking Policy Change on Player Contact Behaviours in 15 to 17 Year Old Midget Ice Hockey Players Using