Patient‐Reported Outcomes One to Five Years After Anterior Cruciate Ligament Reconstruction: The Effect of Combined Injury and Associations With Osteoarthritis Features Defined on Magnetic Resonance Imaging

Abstract

Objective Persistent symptoms and poor quality of life (QoL) are common following anterior cruciate ligament reconstruction (ACLR). We aimed to determine the influence of a combined ACL injury (i.e., concomitant meniscectomy and/or arthroscopic chondral defect at the time of ACLR and/or secondary injury/surgery to ACLR knee) and cartilage defects defined on magnetic resonance imaging (MRI), bone marrow lesions (BMLs), and meniscal lesions on patient‐reported outcomes 1 to 5 years after ACLR. Methods A total of 80 participants (50 men; mean ± SD age 32 ± 14 years) completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee (IKDC) questionnaires as well as a 3T MRI assessment at 1 and 5 years after ACLR. Median patient‐reported outcome scores were compared between isolated and combined ACL injuries and with published normative values. Using multivariate regression, we evaluated the association between compartment‐specific MRI cartilage, BMLs, and meniscal lesions and patient‐reported outcomes at 1 and 5 years. Results Individuals with a combined injury had significantly worse scores in the KOOS subscale of function in sport and recreation (KOOS sport/rec) and in the IKDC questionnaire at 1 year, and worse scores in the KOOS subscales of pain (KOOS pain), symptoms (KOOS symptoms), and QoL (KOOS QoL) and in the IKDC questionnaire at 5 years compared to those with an isolated injury. Although no feature on MRI was associated with patient‐reported outcomes cross‐sectionally at 1 year, patellofemoral cartilage defects at 1 year were significantly associated with worse 5‐year KOOS symptoms (β = –9.79, 95% confidence interval [95% CI] –16.67, –2.91), KOOS sport/rec (β = –7.94, 95% CI –15.27, –0.61), KOOS QoL (β = –8.29, 95% CI –15.28, –1.29), and IKDC (β = –4.79, 95% CI –9.34, –0.24) scores. Patellofemoral cartilage defects at 5 years were also significantly associated with worse 5‐year KOOS symptoms (β = –6.86, 95% CI –13.49, –0.24) and KOOS QoL (β = –11.71, 95% CI –19.08, –4.33) scores. Conclusion Combined injury and patellofemoral cartilage defects shown on MRI are associated with poorer long‐term outcomes. Clinicians should be vigilant and aware of individuals with these injuries, as such individuals may benefit from targeted interventions to improve QoL and optimize symptoms.

Poor functional performance 1 year after ACL reconstruction increases the risk of early osteoarthritis progression

“…The 1-year and 5-year KOOS and IKDC scores (n=81) have been reported in detail previously 22. Significant (p<0.05) improvement (ie, less knee symptoms, better function and QoL) was observed for all KOOS subscales (except KOOS-Symptoms) and IKDC between 1 and 5 years 22. The mean±SD changes were: pain: 2.8±9; symptoms: 0.5±16.1; sport: 6.0±18.2; QoL: 10.0±18.9 and IKDC: 4.7±10.9.…”

“…Four of the five subscales of the KOOS were assessed (activities of daily living subscale excluded due to ceiling effects in ACL populations). They were completed in by pen and paper or via an online portal (MySQL, Oracle, California, USA and Promptus, DS PRIMA, Melbourne, Australia) with matching instructions to the original paper version, as previously described 22 26. The KOOS and IKDC raw scores were recorded and converted to a percentile score, with 100 being the best possible score (ie, no knee problems).…”

“…The GEE regression was adjusted for presence of a combined injury (noted at time of ACLR, or secondary injury to the index knee), 1-year age, sex, height and weight, due to their potential influence on function and MRI-OA features 7. Linear regression (β, 95% CI) determined the relationship between 1-year functional performance, and change in KOOS/IKDC scores between 1 and 5 years (adjusted for combined injury (noted at time of ACLR, or secondary injury to the index or contralateral knee), 1-year age, sex, height, weight and baseline KOOS/IKDC score, due to their potential to influence function and PROs22). Analyses were performed using Stata V.14.2 with α=0.05.…”

“…Evaluation of risk factors for early OA after ACLR should also include concurrent assessment of change in PROs, given the discordance between knee imaging findings and symptoms 22 23. Functional performance may possess differing relationships with change in individual early OA features and PROs.…”

Exercise-therapy and education for individuals one year after anterior cruciate ligament reconstruction: a pilot randomised controlled trial

“…Following anterior cruciate ligament reconstruction (ACLR), clinical practice guidelines recommend postoperative rehabilitation to continue for at least 9 to 12 months, or until achievement of sport-speci c strength, functional and psychological criteria (67). Yet, many patients have symptoms, muscle weakness and functional de cits that persist beyond 1-year post-ACLR (8,50,61,73), which may increase the risk of reinjury, symptomatic posttraumatic osteoarthritis (OA), and worse knee-related quality of life (QoL) (13,14,23,30,48).…”