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Multicenter Study
. 2015 Oct;23(10):1674-84.
doi: 10.1016/j.joca.2015.05.025. Epub 2015 Jun 11.

KOOS pain as a marker for significant knee pain two and six years after primary ACL reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) prospective longitudinal cohort study

D Wasserstein  1 , L J Huston  2 , S Nwosu  3 ; MOON Group; C C Kaeding  14 , R D Parker, R W Wright, J T Andrish, R G Marx, A Amendola, B R Wolf, E C McCarty, M Wolcott, W R Dunn, K P Spindler
Collaborators, Affiliations
Multicenter Study

KOOS pain as a marker for significant knee pain two and six years after primary ACL reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) prospective longitudinal cohort study

D Wasserstein et al. Osteoarthritis Cartilage. 2015 Oct.

Abstract

Objective: The prevalence of radiographic osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR) approaches 50%, yet the prevalence of significant knee pain is unknown. We applied three different models of Knee injury and Osteoarthritis Outcome Score (KOOS) thresholds for significant knee pain to an ACLR cohort to identify prevalence and risk factors.

Design: Multicenter Orthopaedic Outcomes Network (MOON) prospective cohort patients with a unilateral primary ACLR and normal contralateral knee were assessed at 2 and 6 years. Independent variables included patient demographics, validated Patient Reported Outcomes (PRO; Marx activity score, KOOS), and surgical characteristics. Models included: (1) KOOS criteria for a painful knee = quality of life subscale <87.5 and ≥2 of: KOOSpain <86.1, KOOSsymptoms <85.7, KOOSADL <86.8, or KOOSsports/rec <85.0; (2) KOOSpain subscale score ≤72 (≥2 standard deviations below population mean); (3) 10-point KOOSpain drop from 2 to 6 years. Proportional odds models (alpha ≤ 0.05) were used.

Results: 1761 patients of median age 23 years, median body mass index (BMI) 24.8 kg/m(2) and 56% male met inclusion, with 87% (1530/1761) and 86% (1506/1761) follow-up at 2 and 6 years, respectively. At 6 years, n = 592 (39%), n = 131 (9%) and n = 169 (12%) met criteria for models #1 through #3, respectively. The most consistent and strongest independent risk factor at both time-points was subsequent ipsilateral knee surgery. Low 2-year Marx activity score increased the odds of a painful knee at 6 years.

Conclusions: Significant knee pain is prevalent after ACLR; with those who undergo subsequent ipsilateral surgery at greatest risk. The relationship between pain and structural OA warrants further study.

Keywords: Anterior cruciate ligament reconstruction; Knee Injury and Osteoarthritis Outcome Score (KOOS); Knee pain; Symptomatic osteoarthritis.

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Figures

Figure 1
Figure 1
Flowchart showing the inclusion of participants in the study.
Figure 2
Figure 2
Subsequent ipsilateral surgical procedures at 6 years (“Other arthroscopic” includes hardware removal, meniscal and articular cartilage surgery, infection, arthrolysis/manipulation).
See this image and copyright information in PMC

References

    1. Engebretsen L, Benum P, Fasting O, Molster A, Strand T. A prospective, randomized study of three surgical techniques for treatment of acute ruptures of the anterior cruciate ligament. Am J Sports Med. 1990;18(6):585–90. - PubMed
    1. Grontvedt T, Engebretsen L, Bredland T. Arthroscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone grafts with and without augmentation. A prospective randomized study. J Bone Joint Surg Br. 1996;78(5):817–22. - PubMed
    1. Spindler KP, Wright RW. Clinical practice. Anterior cruciate ligament tear. N Engl J ed. 2008;359(20):2135–42. - PMC - PubMed
    1. Cox CL, Huston LJ, Dunn WR, Reinke EK, Nwosu SK, Parker RD, et al. Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after ACL reconstruction? A 6-year MOON cohort study. Am J Sports Med. 2014;42(5):1058–67. - PMC - PubMed
    1. Muthuri SG, McWilliams DF, Doherty M, Zhang W. History of knee injuries and knee osteoarthritis: a meta-analysis of observational studies. Osteoarthritis and Cartilage. 2011;19:1286–93. - PubMed

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