Patient-Reported Outcome, Return to Sport, and Revision Rates 7-9 Years After Anterior Cruciate Ligament Reconstruction: Results From a Cohort of 2042 Patients

Abstract

Background: Long-term patient-reported outcome measures (PROMs), rates of return to sport, and revision risk after anterior cruciate ligament (ACL) reconstruction (ACLR) are not well understood. Purpose: To provide long-term follow-up of PROMs, return-to-sport rates, and revision rates after ACLR and to identify predictors for poor outcome. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 2042 patients were included in an institutional ACL registry (2009-2013) and longitudinally followed. PROMs were completed preoperatively and at all follow-up time points. Questions regarding return to sport and knee stability were completed at final follow-up. Predictors for poor outcome on the International Knee Documentation Committee (IKDC) score were estimated in a regression model incorporating risk factors such as patient characteristics, graft choice, and concomitant injuries. Revision rates and risk of subsequent non-ACL surgeries were calculated. Results: Autografts were used in 76% of the patients (patellar tendon, 62%; hamstring grafts, 38%). Allografts were used in 24% of patients. The questionnaires were returned by 1045 (51.2%) patients at a mean of 7.2 years (range, 5.0-9.8 years) after surgery. Improvements in IKDC score of >30 points were sustained for all patient categories. The strongest predictor for lesser improvement in IKDC score was a cartilage lesion >2 cm2 identified during surgery. Male sex and college education completion were associated with improved IKDC scores. Meniscal lesions did not predict change) in the IKDC score. A total of 69% of patients had returned to sport after 8.1 years (range, 6.7-9.8 years). The main reason for not returning to sport was fear of reinjury. The revision rate was 7.2% after 9 years (range, 8-11 years), 13% of patients needed subsequent ipsilateral non-ACL surgery, and 6% underwent contralateral ACLR. The absence of a meniscal tear, younger age, and male sex were predictors for revision. Graft choice did not predict PROM results or revision risk. Conclusion: Improvements in IKDC scores were sustained 7 years after ACLR. The strongest predictor for poor outcome was a cartilage lesion >2 cm2. Patients can expect a 70% return-to-sport rate and an 87% chance of their knee feeling stable during daily and athletic activities after 8 years. Young male patients have better PROM scores but a higher risk of revision. There is a 26% chance of subsequent knee surgery within 9 years, including a revision rate of 7%, subsequent non-ACL surgery to the operated knee in 13%, and a 6% chance of contralateral ACLR.

Early ACLR and Risk and Timing of Secondary Meniscal Injury Compared With Delayed ACLR or Nonoperative Treatment: A Time-to-Event Analysis Using Machine Learning

“…Younger age has been identified as a risk factor for overall subsequent surgery as well as meniscal tears. 39,42 This supports the hypothesis that higher activity level and physical demand, in combination with inappropriately timed RTS, may subject the meniscus to greater mechanical stresses before adequate neuromuscular adaptation and healing of primary stabilizers. In a meta-analysis of elite athletes, Lai et al 25 found a mean time of 12 months to RTS; however, evidence for the relationship between RTS timing and graft or meniscal reinjury rates remains ambiguous.…”

Superior results of return to sport after double-bundle versus single-bundle anterior cruciate ligament reconstruction in young active patients

“…Recent studies have demonstrated that a range of contextual factors affect return to sport and clinical outcomes after ACLR, including age, sex, sport participation level, and psychological factors [ 4 , 18 ]. Although clinical results and knee kinematics are similar in most recent studies comparing SB and DB techniques, it is unclear whether data that include ACL reconstruction in all age ranges and activity levels lead to the results.…”

Postless Tape Augmentation for Anterior Cruciate Ligament (ACL) Reconstruction

“… 8 Overall, ACL revision rates range from 7 to 8% at 10 years postoperatively and may be slightly higher in the pediatric population. 9 , 10 …”