Factors Affecting Outcomes and Complications of Primary Anterior Cruciate Ligament Reconstruction: A Retrospective Study of 110 Patients

Abstract

Background: Anterior cruciate ligament injury poses a major effect on the quality of life of patients. Anterior cruciate ligament reconstruction (ACLR) remains the mainstay of treatment.

Purposes: To (1) test for the correlation of patients' characteristics such as body mass index (BMI), age, smoking status, and postoperative infrapatellar numbness with the subjective outcome of primary ACLR and (2) investigate whether postsurgical complications can be related to the studied patients' characteristics.

Study design: Case series; Level of evidence, 4.

Methods: Demographic data and operational notes from patients who underwent primary ACLR at the institute between 2011 and 2022 were extracted. Patients' surgical outcomes were evaluated subjectively using the International Knee Documentation Committee (IKDC) score and the Knee injury and Osteoarthritis Outcome Score (KOOS). Pre- and postoperative scoring were completed at postoperative follow-up in December of 2022, patients completed both the IKDC and the KOOS questionnaires. Patients were asked to rate their knee function out of 10 before and after surgery. This rating was based on the patients' self-assessment of their functional ability without the use of a formal instrument. Knee function was assigned as better, worse, or the same through a comparison of patients' reported scores before and after surgery.

Results: Male patients comprised 108 (98.2%) of the total cohort, the mean ± SD age at the time of surgery was 27.92 ± 7.39 years, and BMI was 26.54 ± 3.89. The mean follow-up time was 48.92 ± 27.99 months. Most patients did not need postsurgical intervention (n = 97; 88.2%), while 4 (3.6%), 7 (6.4%), and 2 (1.8%) needed revision, debridement, or both, respectively. The mean IKDC score and KOOS, respectively, were 74.37 ± 20.17 and 85.50 ± 14.83. Patients' BMI had a significant effect on IKDC score (74.68 ± 20.0; P < .001), and infrapatellar numbness after surgery also affected patients' IKDC score (P = .002) and KOOS (P = .043). The age at the time of ACLR was associated with contralateral leg surgery (P = .017).

Conclusion: This study showed that higher BMI and infrapatellar numbness negatively affect the subjective outcomes after primary ACLR. Older age at the time of primary ACLR was associated with a higher likelihood of surgery in the contralateral leg.

Keywords: ACL; complication; epidemiology; football (soccer); general sports trauma; knee; outcome; physical therapy/rehabilitation; reconstruction; risk factor.

Figure 1.

Flowchart for the screening process. *Patients with previous knee surgery, injury to other ligaments, revision of surgery, generalized joint laxity, or no contact information.

Figure 2.

Bar chart of International Knee Documentation Committee (IKDC) score and Knee injury and Osteoarthritis Outcome Score (KOOS) based on knee function after surgery.

Figure 3.

Effect of age at time of surgery on the chance of developing meniscal injury compared with the timing from injury to surgery. The red line indicates the difference in the mean time interval from injury to surgery between patients who sustained a meniscal injury and those who did not sustain a meniscal injury.