Open AccessAge, gender, quadriceps strength and hop test performance are the most important factors affecting the achievement of a patient‐acceptable symptom state after ACL reconstruction
Author(s) -
Cristiani Riccardo,
Mikkelsen Christina,
Edman Gunnar,
Forssblad Magnus,
Engström Björn,
Stålman Anders
Publication year - 2020
Publication title -
knee surgery, sports traumatology, arthroscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.806
H-Index - 125
eISSN - 1433-7347
pISSN - 0942-2056
DOI - 10.1007/s00167-019-05576-2
Subject(s) - medicine , hamstring , physical therapy , anterior cruciate ligament reconstruction , rehabilitation , anterior cruciate ligament , cohort , odds ratio , logistic regression , activities of daily living , osteoarthritis , cohort study , meniscus , surgery , alternative medicine , pathology , physics , incidence (geometry) , optics
Purpose To assess the percentage of patients achieving an acceptable symptom state 2 years after primary anterior cruciate ligament reconstruction (ACLR) and to identify factors affecting its achievement, in a large cohort. Methods Patients who underwent primary ACLR at Capio Artro Clinic, Stockholm, Sweden, from 2005 to 2015, were identified in our clinic registry. Patients who had completed the Knee injury and Osteoarthritis Outcome Score (KOOS) at the 2‐year follow‐up were included. The primary outcome was the achievement of a patient‐acceptable symptom state (PASS) for each KOOS subscale. A multivariate logistic regression analysis was used to determine whether patient age, gender, time from injury to surgery, pre‐injury Tegner activity level, graft type, cartilage injury, the presence of medial meniscus (MM) or lateral meniscus (LM) resection or repair and the recovery of 6‐month symmetrical (limb symmetry index [LSI] of ≥ 90%) isokinetic quadriceps or hamstring strength and single‐leg‐hop test performance were factors associated with the achievement of a PASS for each KOOS subscale. Results A total of 2335 primary ACLRs were included. More than 60% of the patients reported a PASS on four of the five KOOS subscales. Age ≥ 30 years and an LSI of ≥ 90% for 6‐month isokinetic quadriceps strength increased the odds of achieving a PASS across all KOOS subscales. Female gender reduced the odds of achieving a PASS on the Pain (OR 0.76; 95% CI 0.62–0.94; P = 0.01), activities of daily living (ADL) (OR 0.79; 95% CI 0.64–0.97; P = 0.02) and sport and recreation (OR 0.72; 95% CI 0.58–0.89; P = 0.003) subscales. The presence of an MM repair reduced the odds of achieving a PASS on the Pain (OR 0.59; 95% CI 0.36–0.96; P = 0.03) subscale. Hamstring tendon (HT) autograft rather than bone‐patellar tendon‐bone (BPTB) autograft showed increased odds (OR 2.02; 95% CI 1.31–3.10; P = 0.001), whereas a cartilage injury showed reduced odds (OR 0.73; 95% CI 0.55–0.97; P = 0.03) of achieving a PASS on the sport and recreation subscale. An LSI of ≥ 90% for 6‐month single‐leg‐hop test performance increased the odds of achieving a PASS on the ADL (OR 1.37; 95% CI 1.09–1.71; P = 0.005), Sport and Recreation (OR 1.40; 95% CI 1.11–1.77; P = 0.004), and quality of life (OR 1.28; 95% CI 1.00–1.63; P = 0.04) subscales. Conclusion More than 60% of the patients reported an acceptable symptom state on four of the five KOOS subscales 2 years after primary ACLR. Age ≥ 30 years and female gender were the non‐modifiable factors that consistently increased and reduced, respectively, the odds of achieving a PASS. A symmetrical 6‐month isokinetic quadriceps strength and single‐leg‐hop test performance were the modifiable factors that consistently increased the opportunity of achieving a PASS 2 years after primary ACLR. Level of evidence III.