Asian, Hispanic and black patients who underwent ACL reconstruction had a similar or lower risk of undergoing elective ACL revision compared with white patients. In results of this published study, white patients had the lowest unadjusted revision-free survival over time.
In a retrospective cohort study, Ronald A. Navarro, MD, regional chief of orthopedic surgery for Southern California Permanente Medical Group, and colleagues used multivariable Cox proportional-hazard models to evaluate the association between race/ethnicity and revision risk among 27,258 patients who underwent ACL reconstruction from 2008 to 2015.
Differences between race, ethnicity
Researchers categorized race/ethnicity as non-Hispanic white (49.8%), black (8.3%), Hispanic (28.3%) and Asian (13.7%), and adjusted for age, sex, highest educational attainment, annual household income, graft type and geographic region in which the ACL reconstruction was performed.
Results showed the lowest unadjusted revision-free survival over time among white patients, with the cumulative probability of revision highest for white patients followed by Hispanic, black and Asian patients at 5 years postoperatively. When adjusted for potential confounders, researchers found a lower risk of undergoing revision surgery among Asian and Hispanic patients vs. white patients. Although revision risk did not differ between black and white patients before 3.5 years after primary ACL reconstruction, results showed black patients had a lower risk of undergoing revision surgery after 3.5 years.
“It is surprising that we find the non-white population would have a lower risk, but a revision for an ACL reconstruction is largely a choice,” Navarro told Orthopedics Today. “It is only the most unstable knees that would probably have to be revised without regard to choice, but a lot of people just cope with a loose knee. Because our endpoint was a revision surgery, we do not know how many patients are walking around out there with a potentially failed ACL and have chosen not to revise it.”
Larger datasets needed
According to Navarro, future research should focus on why there is a difference in revision rates among different races/ethnicities and whether such differences are due to coping, socioeconomic status or there are, in fact, biologic differences. Larger datasets with more specific race and ethnicity designations are needed to confirm these differences between race/ethnicity exist, he said.
“It would be nice to do a population health study asking why [patients] chose not to undergo revision,” Navarro said. “That would be a big contribution to the ACL injury and reconstruction literature, to know why certain people choose not to go back to get their re- reconstruction done in a way that is more patient survey based. That type of study would not be about the kinematics or the stability of the knee, but more about patient notions as to why they would choose to get another surgery because it is an elective surgical revision for a failed ACL reconstruction,” he said. – by Casey Tingle
- Navarro RA, et al. J Bone Joint Surg Am. 2019;doi:10.2106/JBJS.18.01408.
- For more information:
Ronald A. Navarro, MD, can be reached at 25821 S. Vermont Ave., Harbor City, CA 90710; email: email@example.com.
Disclosure: Navarro reports no relevant financial disclosures.