Background: We are not aware of any previous studies in which
independent measurements of function with validated outcome questionnaires
such as the Knee Injury and Osteoarthritis Outcome Score and the International
Knee Documentation Committee score were evaluated five years after
reconstruction of the anterior cruciate ligament. We hypothesized that patient
demographics, mechanism of injury, and intra-articular injuries and their
treatment are factors associated with function five years after reconstruction
of the anterior cruciate ligament.
Methods: A consecutive series of unilateral, arthroscopically
assisted primary reconstructions of the anterior cruciate ligament performed
by one surgeon using a patellar tendon graft was evaluated. Data on patient
demographics, injury variables, and intra-articular lesions noted at the time
of surgery were collected prospectively. Multivariable regression analysis was
used to identify independent predictors of outcomes as measured with five
questionnaires.
Results: Sixty-nine percent (217) of 314 knees with a reconstruction
of the anterior cruciate ligament were followed for an average of 5.4 years.
The average age at the time of the operation was twenty-seven years.
Independent predictors of a worse outcome, which was measured with the overall
Knee Injury and Osteoarthritis Outcome Score, the International Knee
Documentation Committee score, the Lysholm score, and the Western Ontario and
McMaster Universities Osteoarthritis Index score, included the patient's
recollection of hearing or feeling a pop at the time of the injury, a weight
gain of >15 lb (6.8 kg), and no change in educational level since the
surgery. There was a lack of association between the outcome and either the
occurrence or the form of treatment of a meniscal tear or chondromalacia of
the articular cartilage.
Conclusions: To our knowledge, we performed the first prospective
cohort study to evaluate the prognosis following reconstruction of the
anterior cruciate ligament by identifying significant associations between
multiple variables and clinical outcomes as measured with validated
questionnaires. The clinician can counsel patients about the intermediate-term
functional outcomes of reconstructions of the anterior cruciate ligament on
the basis of these findings. Suggestions regarding weight control and future
education may improve intermediate-term outcomes.
Level of Evidence: Prognostic Level II. See Instructions
to Authors for a complete description of levels of evidence.