Effect of High-Grade Preoperative Knee Laxity on 6-Year Anterior Cruciate Ligament Reconstruction Outcomes

MOON knee Group

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Knee laxity in the setting of anterior cruciate ligament (ACL) injury is often assessed through physical examination using the Lachman, pivot shift, and anterior drawer tests. The degree of laxity noted on these examinations may influence treatment decisions and prognosis. Hypothesis: Increased preoperative knee laxity is associated with increased risk of revision ACL reconstruction, increased risk of contralateral ACL reconstruction, and poorer patient-reported outcomes at 6 years postoperatively. Study Design: Cohort study; Level of evidence, 2. Methods: 2333 patients who underwent primary isolated ACL reconstruction without additional ligament injury were identified. Patients reported by the operating surgeons to have an International Knee Documentation Committee (IKDC) grade D Lachman, anterior drawer, or pivot shift examination were classified as having a high-grade laxity. Multiple logistic regression models were used to evaluate whether having high-grade preoperative laxity was predictive of increased odds of undergoing subsequent revision or contralateral ACL reconstruction within 6 years of the index procedure, controlling for patient age, sex, body mass index, Marx activity level, sport, graft type, medial meniscal treatment, and lateral meniscal treatment. Multiple linear regression modeling was used to evaluate whether having high-grade preoperative laxity was predictive of poorer IKDC or Knee injury and Osteoarthritis Outcome Score Knee-Related Quality of Life (KOOS-QOL) scores at 6 years postoperatively, after controlling for baseline score, patient age, ethnicity, sex, body mass index, marital status, smoking status, sport participation, competition level, Marx activity rating score, graft type, and articular cartilage and meniscal status. Results: In total, 743 of 2325 patients (32.0%) were noted to have high-grade laxity on at least 1 physical examination test. High-grade Lachman was noted in 334 patients (14.4%), high-grade pivot shift was noted in 617 patients (26.5%), and high-grade anterior drawer was noted in 233 patients (10.0%). Six-year revision and contralateral ACL reconstruction data were available for 2129 patients (91.6%). High-grade prereconstruction Lachman was associated with significantly increased odds of ACL graft revision (odds ratio [OR], 1.76; 95% CI, 1.10-2.80, P =.02) and contralateral ACL reconstruction (OR, 1.68; 95% CI, 1.09-2.69; P =.019). High-grade prereconstruction pivot shift was associated with significantly increased odds of ACL graft revision (OR, 1.75; 95% CI, 1.19-2.54, P =.002) but not with significantly increased odds of contralateral ACL reconstruction (OR, 1.30; 95% CI, 0.89-1.87; P =.16). High-grade prereconstruction laxity was associated with statistically significantly lower 6-year IKDC (β = −2.26, P =.003), KOOS-QOL (β = −2.67, P =.015), and Marx activity scores (β = −0.54, P =.020), but these differences did not approach clinically relevant differences in patient-reported outcomes. Conclusion: High-grade preoperative knee laxity is predictive of increased odds of revision ACL reconstruction and contralateral ACL reconstruction 6 years after ACL reconstruction. Poorer patient-reported outcome scores in the high-grade laxity group were also noted, but the difference did not reach a level of clinical relevance.

Original languageEnglish (US)
Pages (from-to)2865-2872
Number of pages8
JournalAmerican Journal of Sports Medicine
Volume46
Issue number12
DOIs
StatePublished - Oct 1 2018
Externally publishedYes

Fingerprint

Anterior Cruciate Ligament Reconstruction
Knee
Odds Ratio
Documentation
Transplants
Knee Injuries
Knee Osteoarthritis
Anterior Cruciate Ligament
Physical Examination
Sports
Body Mass Index
Logistic Models
Quality of Life
Marital Status
Articular Cartilage
Ligaments
Linear Models
Cohort Studies
Therapeutics
Smoking

Keywords

  • anterior cruciate ligament
  • anterior drawer test
  • knee laxity
  • Lachman test
  • pivot shift test

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Effect of High-Grade Preoperative Knee Laxity on 6-Year Anterior Cruciate Ligament Reconstruction Outcomes. / MOON knee Group.

In: American Journal of Sports Medicine, Vol. 46, No. 12, 01.10.2018, p. 2865-2872.

Research output: Contribution to journalArticle

@article{3fc938367b2b48e2a94b5c99c9991364,
title = "Effect of High-Grade Preoperative Knee Laxity on 6-Year Anterior Cruciate Ligament Reconstruction Outcomes",
abstract = "Background: Knee laxity in the setting of anterior cruciate ligament (ACL) injury is often assessed through physical examination using the Lachman, pivot shift, and anterior drawer tests. The degree of laxity noted on these examinations may influence treatment decisions and prognosis. Hypothesis: Increased preoperative knee laxity is associated with increased risk of revision ACL reconstruction, increased risk of contralateral ACL reconstruction, and poorer patient-reported outcomes at 6 years postoperatively. Study Design: Cohort study; Level of evidence, 2. Methods: 2333 patients who underwent primary isolated ACL reconstruction without additional ligament injury were identified. Patients reported by the operating surgeons to have an International Knee Documentation Committee (IKDC) grade D Lachman, anterior drawer, or pivot shift examination were classified as having a high-grade laxity. Multiple logistic regression models were used to evaluate whether having high-grade preoperative laxity was predictive of increased odds of undergoing subsequent revision or contralateral ACL reconstruction within 6 years of the index procedure, controlling for patient age, sex, body mass index, Marx activity level, sport, graft type, medial meniscal treatment, and lateral meniscal treatment. Multiple linear regression modeling was used to evaluate whether having high-grade preoperative laxity was predictive of poorer IKDC or Knee injury and Osteoarthritis Outcome Score Knee-Related Quality of Life (KOOS-QOL) scores at 6 years postoperatively, after controlling for baseline score, patient age, ethnicity, sex, body mass index, marital status, smoking status, sport participation, competition level, Marx activity rating score, graft type, and articular cartilage and meniscal status. Results: In total, 743 of 2325 patients (32.0{\%}) were noted to have high-grade laxity on at least 1 physical examination test. High-grade Lachman was noted in 334 patients (14.4{\%}), high-grade pivot shift was noted in 617 patients (26.5{\%}), and high-grade anterior drawer was noted in 233 patients (10.0{\%}). Six-year revision and contralateral ACL reconstruction data were available for 2129 patients (91.6{\%}). High-grade prereconstruction Lachman was associated with significantly increased odds of ACL graft revision (odds ratio [OR], 1.76; 95{\%} CI, 1.10-2.80, P =.02) and contralateral ACL reconstruction (OR, 1.68; 95{\%} CI, 1.09-2.69; P =.019). High-grade prereconstruction pivot shift was associated with significantly increased odds of ACL graft revision (OR, 1.75; 95{\%} CI, 1.19-2.54, P =.002) but not with significantly increased odds of contralateral ACL reconstruction (OR, 1.30; 95{\%} CI, 0.89-1.87; P =.16). High-grade prereconstruction laxity was associated with statistically significantly lower 6-year IKDC (β = −2.26, P =.003), KOOS-QOL (β = −2.67, P =.015), and Marx activity scores (β = −0.54, P =.020), but these differences did not approach clinically relevant differences in patient-reported outcomes. Conclusion: High-grade preoperative knee laxity is predictive of increased odds of revision ACL reconstruction and contralateral ACL reconstruction 6 years after ACL reconstruction. Poorer patient-reported outcome scores in the high-grade laxity group were also noted, but the difference did not reach a level of clinical relevance.",
keywords = "anterior cruciate ligament, anterior drawer test, knee laxity, Lachman test, pivot shift test",
author = "{MOON knee Group} and Magnussen, {Robert A.} and Reinke, {Emily K.} and Huston, {Laura J.} and Timothy Hewett and Spindler, {Kurt P.} and Annunziato Amendola and Andrish, {Jack T.} and Brophy, {Robert H.} and Dunn, {Warren R.} and Flanigan, {David C.} and Jones, {Morgan H.} and Kaeding, {Christopher C.} and Marx, {Robert G.} and Matava, {Matthew J.} and Parker, {Richard D.} and Vidal, {Armando F.} and Wolcott, {Michelle L.} and Wolf, {Brian R.} and Wright, {Rick W.}",
year = "2018",
month = "10",
day = "1",
doi = "10.1177/0363546518793881",
language = "English (US)",
volume = "46",
pages = "2865--2872",
journal = "American Journal of Sports Medicine",
issn = "0363-5465",
publisher = "SAGE Publications Inc.",
number = "12",

}

TY - JOUR

T1 - Effect of High-Grade Preoperative Knee Laxity on 6-Year Anterior Cruciate Ligament Reconstruction Outcomes

AU - MOON knee Group

AU - Magnussen, Robert A.

AU - Reinke, Emily K.

AU - Huston, Laura J.

AU - Hewett, Timothy

AU - Spindler, Kurt P.

AU - Amendola, Annunziato

AU - Andrish, Jack T.

AU - Brophy, Robert H.

AU - Dunn, Warren R.

AU - Flanigan, David C.

AU - Jones, Morgan H.

AU - Kaeding, Christopher C.

AU - Marx, Robert G.

AU - Matava, Matthew J.

AU - Parker, Richard D.

AU - Vidal, Armando F.

AU - Wolcott, Michelle L.

AU - Wolf, Brian R.

AU - Wright, Rick W.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background: Knee laxity in the setting of anterior cruciate ligament (ACL) injury is often assessed through physical examination using the Lachman, pivot shift, and anterior drawer tests. The degree of laxity noted on these examinations may influence treatment decisions and prognosis. Hypothesis: Increased preoperative knee laxity is associated with increased risk of revision ACL reconstruction, increased risk of contralateral ACL reconstruction, and poorer patient-reported outcomes at 6 years postoperatively. Study Design: Cohort study; Level of evidence, 2. Methods: 2333 patients who underwent primary isolated ACL reconstruction without additional ligament injury were identified. Patients reported by the operating surgeons to have an International Knee Documentation Committee (IKDC) grade D Lachman, anterior drawer, or pivot shift examination were classified as having a high-grade laxity. Multiple logistic regression models were used to evaluate whether having high-grade preoperative laxity was predictive of increased odds of undergoing subsequent revision or contralateral ACL reconstruction within 6 years of the index procedure, controlling for patient age, sex, body mass index, Marx activity level, sport, graft type, medial meniscal treatment, and lateral meniscal treatment. Multiple linear regression modeling was used to evaluate whether having high-grade preoperative laxity was predictive of poorer IKDC or Knee injury and Osteoarthritis Outcome Score Knee-Related Quality of Life (KOOS-QOL) scores at 6 years postoperatively, after controlling for baseline score, patient age, ethnicity, sex, body mass index, marital status, smoking status, sport participation, competition level, Marx activity rating score, graft type, and articular cartilage and meniscal status. Results: In total, 743 of 2325 patients (32.0%) were noted to have high-grade laxity on at least 1 physical examination test. High-grade Lachman was noted in 334 patients (14.4%), high-grade pivot shift was noted in 617 patients (26.5%), and high-grade anterior drawer was noted in 233 patients (10.0%). Six-year revision and contralateral ACL reconstruction data were available for 2129 patients (91.6%). High-grade prereconstruction Lachman was associated with significantly increased odds of ACL graft revision (odds ratio [OR], 1.76; 95% CI, 1.10-2.80, P =.02) and contralateral ACL reconstruction (OR, 1.68; 95% CI, 1.09-2.69; P =.019). High-grade prereconstruction pivot shift was associated with significantly increased odds of ACL graft revision (OR, 1.75; 95% CI, 1.19-2.54, P =.002) but not with significantly increased odds of contralateral ACL reconstruction (OR, 1.30; 95% CI, 0.89-1.87; P =.16). High-grade prereconstruction laxity was associated with statistically significantly lower 6-year IKDC (β = −2.26, P =.003), KOOS-QOL (β = −2.67, P =.015), and Marx activity scores (β = −0.54, P =.020), but these differences did not approach clinically relevant differences in patient-reported outcomes. Conclusion: High-grade preoperative knee laxity is predictive of increased odds of revision ACL reconstruction and contralateral ACL reconstruction 6 years after ACL reconstruction. Poorer patient-reported outcome scores in the high-grade laxity group were also noted, but the difference did not reach a level of clinical relevance.

AB - Background: Knee laxity in the setting of anterior cruciate ligament (ACL) injury is often assessed through physical examination using the Lachman, pivot shift, and anterior drawer tests. The degree of laxity noted on these examinations may influence treatment decisions and prognosis. Hypothesis: Increased preoperative knee laxity is associated with increased risk of revision ACL reconstruction, increased risk of contralateral ACL reconstruction, and poorer patient-reported outcomes at 6 years postoperatively. Study Design: Cohort study; Level of evidence, 2. Methods: 2333 patients who underwent primary isolated ACL reconstruction without additional ligament injury were identified. Patients reported by the operating surgeons to have an International Knee Documentation Committee (IKDC) grade D Lachman, anterior drawer, or pivot shift examination were classified as having a high-grade laxity. Multiple logistic regression models were used to evaluate whether having high-grade preoperative laxity was predictive of increased odds of undergoing subsequent revision or contralateral ACL reconstruction within 6 years of the index procedure, controlling for patient age, sex, body mass index, Marx activity level, sport, graft type, medial meniscal treatment, and lateral meniscal treatment. Multiple linear regression modeling was used to evaluate whether having high-grade preoperative laxity was predictive of poorer IKDC or Knee injury and Osteoarthritis Outcome Score Knee-Related Quality of Life (KOOS-QOL) scores at 6 years postoperatively, after controlling for baseline score, patient age, ethnicity, sex, body mass index, marital status, smoking status, sport participation, competition level, Marx activity rating score, graft type, and articular cartilage and meniscal status. Results: In total, 743 of 2325 patients (32.0%) were noted to have high-grade laxity on at least 1 physical examination test. High-grade Lachman was noted in 334 patients (14.4%), high-grade pivot shift was noted in 617 patients (26.5%), and high-grade anterior drawer was noted in 233 patients (10.0%). Six-year revision and contralateral ACL reconstruction data were available for 2129 patients (91.6%). High-grade prereconstruction Lachman was associated with significantly increased odds of ACL graft revision (odds ratio [OR], 1.76; 95% CI, 1.10-2.80, P =.02) and contralateral ACL reconstruction (OR, 1.68; 95% CI, 1.09-2.69; P =.019). High-grade prereconstruction pivot shift was associated with significantly increased odds of ACL graft revision (OR, 1.75; 95% CI, 1.19-2.54, P =.002) but not with significantly increased odds of contralateral ACL reconstruction (OR, 1.30; 95% CI, 0.89-1.87; P =.16). High-grade prereconstruction laxity was associated with statistically significantly lower 6-year IKDC (β = −2.26, P =.003), KOOS-QOL (β = −2.67, P =.015), and Marx activity scores (β = −0.54, P =.020), but these differences did not approach clinically relevant differences in patient-reported outcomes. Conclusion: High-grade preoperative knee laxity is predictive of increased odds of revision ACL reconstruction and contralateral ACL reconstruction 6 years after ACL reconstruction. Poorer patient-reported outcome scores in the high-grade laxity group were also noted, but the difference did not reach a level of clinical relevance.

KW - anterior cruciate ligament

KW - anterior drawer test

KW - knee laxity

KW - Lachman test

KW - pivot shift test

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