Abstract
Objectives:
Anterior cruciate ligament (ACL) reconstruction is a commonly performed orthopaedic procedure, with mixed long-term outcomes in terms of reinjury and return to sports. The aim of this study was to investigate factors associated with clinically meaningful long term outcomes after ACL reconstruction, as measured by the Patient Acceptable Symptom State (PASS). Additionally, the study aimed to evaluate for differences in factors between male and female patients undergoing ACL reconstruction.
Methods:
Patients above the age of 14 years who underwent ACL reconstruction at a single institution were identified retrospectively. Data on demographics, operative notes, and medical history were recorded from the electronic medical records. These patients were contacted to obtain information about subsequent diagnoses and surgeries since their surgery, as well as the current state of their knee via the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation form. PASS was defined an IKDC score of 75.9 or higher based on the threshold identified by Muller et al. Univariate logistic regression was performed to identify predictors of achieving PASS, and variables were selected for inclusion in a multivariable logistic regression model based on univariate analysis, prior literature, and clinical relevance. Multivariate regression was stratified by sex.
Results:
A total of 479 patients (age 38 ± 13, 57% female) were included in the study with a mean follow up of 10 ± 5 years. Mean IKDC was 80.50 (16.3) (80.54 in males vs 80.45 in females, p > 0.9). PASS was achieved by 68% of patients (69% in males vs 67% in females, p = 0.6). Nine patients (1.9%) reported undergoing subsequent revision surgery (4 (2.0%) in males vs 5 (1.8%) in females, p > 0.9). Upon univariate analysis, age, body mass index (BMI), meniscectomy, revisions and skiing were identified as potential predictors for the multivariable model. Multivariable analysis found that higher BMI (odds ratio 0.95[0.91, 0.99], p = 0.019) and revisions (odds ratio 0.2 [0.04, 0.78], p = 0.025) had independent, negative associations with achievement of PASS. Participation in skiing (odds ratio 1.81 [1.12,2.99], p = 0.018) was found to be positively and independently associated with achieving PASS. Among males, higher BMI (0.9 [0.83, 0.99], p = 0.023) was negatively associated with PASS and participation in skiing (3.52 [1.63, 8.38], p = .002) was positively associated with PASS. Among females, revisions (OR 0.09 [0.00,0.63], p = 0.034) were negatively associated with achievement of PASS.
Conclusions:
At 10 years after ACL reconstruction, most patients reported an acceptable symptom state. Sex differences were observed in factors associated with achieving PASS after ACL reconstruction. Among males, BMI and skiing were found to be associated with PASS, while among females, revision surgery was a significant predictor. These results highlight the need for further investigation of sex-specific factors in ACL reconstruction outcomes.
