Sports activity and quality of life improve after isolated ACL, isolated PCL, and combined ACL/PCL reconstruction

Abstract

Purpose: To compare patient-reported outcomes following isolated anterior cruciate ligament reconstruction (ACL-R), isolated posterior cruciate ligament reconstruction (PCL-R), and combined ACL-R and PCL-R (ACL/PCL-R), at a minimum follow-up of 2 years.

Methods: This was a prospective observational registry cohort study based on the Swedish National Knee Ligament Registry. Patients undergoing isolated ACL-R, isolated PCL-R, and combined ACL/PCL-R between 2005 and 2019 were eligible for inclusion. Demographic characteristics as well as injury- and surgery-related data were queried from the SNKLR. To evaluate functional outcomes, the Knee Injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 1- and 2-year follow-ups and compared between the treatment groups.

Results: In total, 45,169 patients underwent isolated ACL-R, 192 patients isolated PCL-R, and 203 patients combined ACL/PCL-R. Preoperatively, and at the 1- and 2-year follow-ups, KOOS subscales were highest for the isolated ACL-R group, followed by the isolated PCL-R, and lowest for the combined ACL/PCL-R groups. Significant improvements were observed across all treatment groups in the majority of KOOS subscales between the preoperative, and 1- and 2-year follow-ups. All treatment groups showed the greatest improvements between the preoperative and 2-year follow-ups in the knee-related quality of life (mean improvement: isolated ACL-R, + 28 points; isolated PCL-R, + 23 points; combined ACL/PCL-R, + 21 points) and the function in sport and recreation (mean improvement: isolated ACL-R, + 26 points; isolated PCL-R, + 20 points; combined ACL/PCL-R, + 19 points) subscales.

Conclusion: Clinically relevant improvements in knee function can be expected after isolated ACL-R, isolated PCL-R, and combined ACL/PCL-R. Functional improvements were particularly pronounced in the KOOS function in sport and recreation subscale, indicating the importance of knee stability for sports activity. This study facilitates more comprehensive patient education about functional expectations after surgical treatment of isolated and combined ACL and PCL injuries.

Level of evidence: Level 2.

Keywords: ACL; Anterior cruciate ligament; KOOS; Multiligament knee injury; PCL; Patient-reported outcomes; Posterior cruciate ligament; Schenck classification.

Fig. 1

Flow-chart of patient enrollment. Complete data input refers to data available for all KOOS subscales. ACL-R anterior cruciate ligament reconstruction, ACL/PCL-R combined anterior cruciate ligament and posterior cruciate ligament reconstruction, FU follow-up, PCL-R posterior cruciate ligament reconstruction

Fig. 2

Improvements over time. KOOS (A) sport and recreation function (Sports/Rec) and (B) knee-related quality of life (QoL) subscales preoperatively and at the 1-year and 2-year follow-ups. Comparison over time was based on the Wilcoxon Signed Rank test. ACL-R anterior cruciate ligament reconstruction, ACL/PCL-R anterior cruciate ligament and posterior cruciate ligament reconstruction, PCL-R posterior cruciate ligament reconstruction; *Statistically significant difference (p < 0.05), **Statistically significant difference (p < 0.001)