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. 2022 Feb;50(2):423-432.
doi: 10.1177/03635465211060333. Epub 2022 Jan 18.

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

Per-Henrik Randsborg  1   2 , Nicholas Cepeda  1 , Dakota Adamec  1 , Scott A Rodeo  1 , Anil Ranawat  1 , Andrew D Pearle  1
Affiliations

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

Per-Henrik Randsborg et al. Am J Sports Med. 2022 Feb.

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.

Keywords: ACL; IKDC; return to sport; revision.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: A.R. has received consulting fees from Anika Therapeutics, Bodycad USA, Smith & Nephew, Arthrex, Flexion Therapeutics, Stryker, and Heron Therapeutics; royalties from ConforMIS; education support from Gotham Surgical Solutions; and other from Enhatch, Xiros, NewClip, Ranfac, and Marrow Cellution; he also has family members with disclosures for Strathspey Crown and DePuy. A.D.P. has received consulting fees from Zimmer Biomet, Exactech, and Stryker; royalties from Zimmer Biomet; hospitality payments from Smith & Nephew; education support from Arthrex; and other from Engage Surgical. S.A.R. has received royalties from Zimmer Biomet; consulting fees from Advance Medical, Flexion Therapeutics, and Novartix Pharmaceutical; and income from the sale of Rotation Medical to Smith & Nephew (from stock options) and the sale of Cayenne Medical to Zimmer (from stock options); he is an associate editor for AJSM. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Flowchart of included patients. PROM, patient-reported outcome measure.
Figure 2.
Figure 2.
Revision rates at 9 years (range, 8-11 years) after primary anterior cruciate ligament reconstruction by age groups. Revision numbers (R) in each age group: ≤18 years, R = 68 (14.7%); 19-24 years, R = 34 (7.9%); 25-29 years, R = 14 (4.9%); >30 years, R = 32 (3.7%).
See this image and copyright information in PMC

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