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. 2018 Mar;46(4):815-825.
doi: 10.1177/0363546517749850.

Ten-Year Outcomes and Risk Factors After Anterior Cruciate Ligament Reconstruction: A MOON Longitudinal Prospective Cohort Study

MOON Knee Group  1 ; Kurt P Spindler  1 , Laura J Huston  1 , Kevin M Chagin  1 , Michael W Kattan  1 , Emily K Reinke  1 , Annunziato Amendola  1 , Jack T Andrish  1 , Robert H Brophy  1 , Charles L Cox  1 , Warren R Dunn  1 , David C Flanigan  1 , Morgan H Jones  1 , Christopher C Kaeding  1 , Robert A Magnussen  1 , Robert G Marx  1 , Matthew J Matava  1 , Eric C McCarty  1 , Richard D Parker  1 , Angela D Pedroza  1 , Armando F Vidal  1 , Michelle L Wolcott  1 , Brian R Wolf  1 , Rick W Wright  1
Affiliations

Ten-Year Outcomes and Risk Factors After Anterior Cruciate Ligament Reconstruction: A MOON Longitudinal Prospective Cohort Study

MOON Knee Group et al. Am J Sports Med. 2018 Mar.

Abstract

Background: The long-term prognosis and risk factors for quality of life and disability after anterior cruciate ligament (ACL) reconstruction remain unknown. Hypothesis/Purpose: Our objective was to identify patient-reported outcomes and patient-specific risk factors from a large prospective cohort at a minimum 10-year follow-up after ACL reconstruction. We hypothesized that meniscus and articular cartilage injuries, revision ACL reconstruction, subsequent knee surgery, and certain demographic characteristics would be significant risk factors for inferior outcomes at 10 years.

Study design: Therapeutic study; Level of evidence, 2.

Methods: Unilateral ACL reconstruction procedures were identified and prospectively enrolled between 2002 and 2004 from 7 sites in the Multicenter Orthopaedic Outcomes Network (MOON). Patients preoperatively completed a series of validated outcome instruments, including the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), and Marx activity rating scale. At the time of surgery, physicians documented all intra-articular abnormalities, treatment, and surgical techniques utilized. Patients were followed at 2, 6, and 10 years postoperatively and asked to complete the same outcome instruments that they completed at baseline. The incidence and details of any subsequent knee surgeries were also obtained. Multivariable regression analysis was used to identify significant predictors of the outcome.

Results: A total of 1592 patients were enrolled (57% male; median age, 24 years). Ten-year follow-up was obtained on 83% (n = 1320) of the cohort. Both IKDC and KOOS scores significantly improved at 2 years and were maintained at 6 and 10 years. Conversely, Marx scores dropped markedly over time, from a median score of 12 points at baseline to 9 points at 2 years, 7 points at 6 years, and 6 points at 10 years. The patient-specific risk factors for inferior 10-year outcomes were lower baseline scores; higher body mass index; being a smoker at baseline; having a medial or lateral meniscus procedure performed before index ACL reconstruction; undergoing revision ACL reconstruction; undergoing lateral meniscectomy; grade 3 to 4 articular cartilage lesions in the medial, lateral, or patellofemoral compartments; and undergoing any subsequent ipsilateral knee surgery after index ACL reconstruction.

Conclusion: Patients were able to perform sports-related functions and maintain a relatively high knee-related quality of life 10 years after ACL reconstruction, although activity levels significantly declined over time. Multivariable analysis identified several key modifiable risk factors that significantly influence the outcome.

Keywords: ACL reconstruction; IKDC; KOOS; Marx; anterior cruciate ligament; articular cartilage; follow-up; meniscus; outcomes; revision ACL reconstruction; subsequent surgery.

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Figures

Figure 1
Figure 1
Enrollment Flow Diagram
Figure 2
Figure 2
10-Year Patient-Reported Outcomes over Time (Population Means). Figure 2a: KOOS profile over time; Figure 2b: IKDC profile over time; Figure 2c: Marx activity level profile over time.
Figure 2
Figure 2
10-Year Patient-Reported Outcomes over Time (Population Means). Figure 2a: KOOS profile over time; Figure 2b: IKDC profile over time; Figure 2c: Marx activity level profile over time.
Figure 3
Figure 3
The relative strength of association between predictor variables and IKDC (3a), KOOS (symptoms subscale – 3b; pain subscale – 3c; activities of daily living (ADL) – 3d; sports and recreation subscale – 3e; quality of life (QOL) – 3f), and Marx activity levels (3g) at 10 years. Key: reconstruction type = primary versus revision ACL reconstruction; AC = articular cartilage; BMI = body mass index; IL = ipsilateral.
Figure 3
Figure 3
The relative strength of association between predictor variables and IKDC (3a), KOOS (symptoms subscale – 3b; pain subscale – 3c; activities of daily living (ADL) – 3d; sports and recreation subscale – 3e; quality of life (QOL) – 3f), and Marx activity levels (3g) at 10 years. Key: reconstruction type = primary versus revision ACL reconstruction; AC = articular cartilage; BMI = body mass index; IL = ipsilateral.
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References

    1. Ahn JH, Kim JG, Wang JH, Jung CH, Lim HC. Long-term results of anterior cruciate ligament reconstruction using bone-patellar tendon-bone: an analysis of the factors affecting the development of osteoarthritis. Arthroscopy. 2012;28(8):1114–1123. - PubMed
    1. Ait Si Selmi T, Fithian D, Neyret P. The evolution of osteoarthritis in 103 patients with ACL reconstruction at 17 years follow-up. Knee. 2006;13(5):353–358. - PubMed
    1. Ardern CL, Sonesson S, Forssblad M, Kvist J. Comparison of patient-reported outcomes among those who chose ACL reconstruction or non-surgical treatment. Scand J Med Sci Sports. 2016 Jun 23; doi: 10.1111/sms.12707. Epub ahead of print. - DOI - PubMed
    1. Barenius B, Ponzer S, Shalabi A, Bujak R, Norlen L, Eriksson K. Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial. Am J Sports Med. 2014;42(5):1049–1057. - PubMed
    1. Bekkers JE, de Windt TS, Raijmakers NJ, Dhert WJ, Saris DB. Validation of the Knee Injury and Osteoarthritis Outcome Score (KOOS) for the treatment of focal cartilage lesions. Osteoarthritis Cartilage. 2009;17(11):1434–1439. - PubMed

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