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

Robert A. Magnussen, Emily K. Reinke, Laura J. Huston, Timothy Hewett, Kurt P. Spindler, Jack T. Andrish, Morgan H. Jones, Richard D. Parker, Eric C. McCarty, Robert G. Marx, Annunziato Amendola, Brian R. Wolf, David C. Flanigan, Christopher C. Kaeding, Robert H. Brophy, Matthew J. Matava, Rick W. Wright, Warren R. Dunn

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Knee laxity in the setting of suspected anterior cruciate ligament (ACL) injury is frequently 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 would be associated with increased risk of subsequent revision ACL reconstruction and worse patient-reported outcomes 2 years postoperatively. Study Design: Cohort study; Level of evidence, 2. Methods: From an ongoing prospective cohort study, 2333 patients who underwent primary isolated ACL reconstruction without collateral or posterior cruciate ligament injury were identified. Patients reported by the operating surgeons as having an International Knee Documentation Committee (IKDC) grade D for Lachman, anterior drawer, or pivot-shift examination were classified as having high-grade laxity. Multiple logistic regression modeling was used to evaluate whether having high-grade preoperative laxity was associated with increased odds of undergoing revision ACL reconstruction within 2 years of the index procedure, controlling for patient age, sex, Marx activity level, level of competition, and graft type. Multiple linear regression modeling was used to evaluate whether having high-grade preoperative laxity was associated with worse IKDC score or Knee injury and Osteoarthritis Outcome Score Knee-Related Quality of Life subscale (KOOS-QOL) scores at a minimum 2 years postoperatively, 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 meniscus status. Results: Pre-reconstruction laxity data were available for 2325 patients (99.7%). Two-year revision data were available for 2259 patients (96.8%), and patient-reported outcomes were available for 1979 patients (84.8%). High-grade preoperative laxity was noted in 743 patients (31.9%). The mean postoperative IKDC score was 81.8 ± 15.9, and the mean KOOS-QOL score was 72.0 ± 22.0. The presence of high-grade pre-reconstruction laxity was associated with significantly increased odds of ACL graft revision (odds ratio [OR] = 1.87 [95% CI, 1.19-2.95]; P =.007). The presence of high-grade pre-reconstruction laxity was not associated with any difference in postoperative IKDC (β = '0.56, P =.44) or KOOS-QOL (β = 0.04, P =.97). Conclusion: The presence of high-grade pre-reconstruction knee laxity as assessed by manual physical examination under anesthesia is associated with significantly increased odds of revision ACL surgery but has no association with patient-reported outcome scores at 2 years after ACL reconstruction.

Original languageEnglish (US)
Pages (from-to)3077-3082
Number of pages6
JournalAmerican Journal of Sports Medicine
Volume44
Issue number12
DOIs
StatePublished - Dec 1 2016

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

Keywords

  • anterior cruciate ligament
  • diagnosis
  • knee laxity
  • knee ligaments

ASJC Scopus subject areas

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

Cite this

Magnussen, R. A., Reinke, E. K., Huston, L. J., Hewett, T., Spindler, K. P., Andrish, J. T., ... Dunn, W. R. (2016). Effect of High-Grade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes. American Journal of Sports Medicine, 44(12), 3077-3082. https://doi.org/10.1177/0363546516656835

Effect of High-Grade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes. / Magnussen, Robert A.; Reinke, Emily K.; Huston, Laura J.; Hewett, Timothy; Spindler, Kurt P.; Andrish, Jack T.; Jones, Morgan H.; Parker, Richard D.; McCarty, Eric C.; Marx, Robert G.; Amendola, Annunziato; Wolf, Brian R.; Flanigan, David C.; Kaeding, Christopher C.; Brophy, Robert H.; Matava, Matthew J.; Wright, Rick W.; Dunn, Warren R.

In: American Journal of Sports Medicine, Vol. 44, No. 12, 01.12.2016, p. 3077-3082.

Research output: Contribution to journalArticle

Magnussen, RA, Reinke, EK, Huston, LJ, Hewett, T, Spindler, KP, Andrish, JT, Jones, MH, Parker, RD, McCarty, EC, Marx, RG, Amendola, A, Wolf, BR, Flanigan, DC, Kaeding, CC, Brophy, RH, Matava, MJ, Wright, RW & Dunn, WR 2016, 'Effect of High-Grade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes', American Journal of Sports Medicine, vol. 44, no. 12, pp. 3077-3082. https://doi.org/10.1177/0363546516656835
Magnussen, Robert A. ; Reinke, Emily K. ; Huston, Laura J. ; Hewett, Timothy ; Spindler, Kurt P. ; Andrish, Jack T. ; Jones, Morgan H. ; Parker, Richard D. ; McCarty, Eric C. ; Marx, Robert G. ; Amendola, Annunziato ; Wolf, Brian R. ; Flanigan, David C. ; Kaeding, Christopher C. ; Brophy, Robert H. ; Matava, Matthew J. ; Wright, Rick W. ; Dunn, Warren R. / Effect of High-Grade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes. In: American Journal of Sports Medicine. 2016 ; Vol. 44, No. 12. pp. 3077-3082.
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abstract = "Background: Knee laxity in the setting of suspected anterior cruciate ligament (ACL) injury is frequently 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 would be associated with increased risk of subsequent revision ACL reconstruction and worse patient-reported outcomes 2 years postoperatively. Study Design: Cohort study; Level of evidence, 2. Methods: From an ongoing prospective cohort study, 2333 patients who underwent primary isolated ACL reconstruction without collateral or posterior cruciate ligament injury were identified. Patients reported by the operating surgeons as having an International Knee Documentation Committee (IKDC) grade D for Lachman, anterior drawer, or pivot-shift examination were classified as having high-grade laxity. Multiple logistic regression modeling was used to evaluate whether having high-grade preoperative laxity was associated with increased odds of undergoing revision ACL reconstruction within 2 years of the index procedure, controlling for patient age, sex, Marx activity level, level of competition, and graft type. Multiple linear regression modeling was used to evaluate whether having high-grade preoperative laxity was associated with worse IKDC score or Knee injury and Osteoarthritis Outcome Score Knee-Related Quality of Life subscale (KOOS-QOL) scores at a minimum 2 years postoperatively, 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 meniscus status. Results: Pre-reconstruction laxity data were available for 2325 patients (99.7{\%}). Two-year revision data were available for 2259 patients (96.8{\%}), and patient-reported outcomes were available for 1979 patients (84.8{\%}). High-grade preoperative laxity was noted in 743 patients (31.9{\%}). The mean postoperative IKDC score was 81.8 ± 15.9, and the mean KOOS-QOL score was 72.0 ± 22.0. The presence of high-grade pre-reconstruction laxity was associated with significantly increased odds of ACL graft revision (odds ratio [OR] = 1.87 [95{\%} CI, 1.19-2.95]; P =.007). The presence of high-grade pre-reconstruction laxity was not associated with any difference in postoperative IKDC (β = '0.56, P =.44) or KOOS-QOL (β = 0.04, P =.97). Conclusion: The presence of high-grade pre-reconstruction knee laxity as assessed by manual physical examination under anesthesia is associated with significantly increased odds of revision ACL surgery but has no association with patient-reported outcome scores at 2 years after ACL reconstruction.",
keywords = "anterior cruciate ligament, diagnosis, knee laxity, knee ligaments",
author = "Magnussen, {Robert A.} and Reinke, {Emily K.} and Huston, {Laura J.} and Timothy Hewett and Spindler, {Kurt P.} and Andrish, {Jack T.} and Jones, {Morgan H.} and Parker, {Richard D.} and McCarty, {Eric C.} and Marx, {Robert G.} and Annunziato Amendola and Wolf, {Brian R.} and Flanigan, {David C.} and Kaeding, {Christopher C.} and Brophy, {Robert H.} and Matava, {Matthew J.} and Wright, {Rick W.} and Dunn, {Warren R.}",
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TY - JOUR

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

AU - Magnussen, Robert A.

AU - Reinke, Emily K.

AU - Huston, Laura J.

AU - Hewett, Timothy

AU - Spindler, Kurt P.

AU - Andrish, Jack T.

AU - Jones, Morgan H.

AU - Parker, Richard D.

AU - McCarty, Eric C.

AU - Marx, Robert G.

AU - Amendola, Annunziato

AU - Wolf, Brian R.

AU - Flanigan, David C.

AU - Kaeding, Christopher C.

AU - Brophy, Robert H.

AU - Matava, Matthew J.

AU - Wright, Rick W.

AU - Dunn, Warren R.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Background: Knee laxity in the setting of suspected anterior cruciate ligament (ACL) injury is frequently 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 would be associated with increased risk of subsequent revision ACL reconstruction and worse patient-reported outcomes 2 years postoperatively. Study Design: Cohort study; Level of evidence, 2. Methods: From an ongoing prospective cohort study, 2333 patients who underwent primary isolated ACL reconstruction without collateral or posterior cruciate ligament injury were identified. Patients reported by the operating surgeons as having an International Knee Documentation Committee (IKDC) grade D for Lachman, anterior drawer, or pivot-shift examination were classified as having high-grade laxity. Multiple logistic regression modeling was used to evaluate whether having high-grade preoperative laxity was associated with increased odds of undergoing revision ACL reconstruction within 2 years of the index procedure, controlling for patient age, sex, Marx activity level, level of competition, and graft type. Multiple linear regression modeling was used to evaluate whether having high-grade preoperative laxity was associated with worse IKDC score or Knee injury and Osteoarthritis Outcome Score Knee-Related Quality of Life subscale (KOOS-QOL) scores at a minimum 2 years postoperatively, 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 meniscus status. Results: Pre-reconstruction laxity data were available for 2325 patients (99.7%). Two-year revision data were available for 2259 patients (96.8%), and patient-reported outcomes were available for 1979 patients (84.8%). High-grade preoperative laxity was noted in 743 patients (31.9%). The mean postoperative IKDC score was 81.8 ± 15.9, and the mean KOOS-QOL score was 72.0 ± 22.0. The presence of high-grade pre-reconstruction laxity was associated with significantly increased odds of ACL graft revision (odds ratio [OR] = 1.87 [95% CI, 1.19-2.95]; P =.007). The presence of high-grade pre-reconstruction laxity was not associated with any difference in postoperative IKDC (β = '0.56, P =.44) or KOOS-QOL (β = 0.04, P =.97). Conclusion: The presence of high-grade pre-reconstruction knee laxity as assessed by manual physical examination under anesthesia is associated with significantly increased odds of revision ACL surgery but has no association with patient-reported outcome scores at 2 years after ACL reconstruction.

AB - Background: Knee laxity in the setting of suspected anterior cruciate ligament (ACL) injury is frequently 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 would be associated with increased risk of subsequent revision ACL reconstruction and worse patient-reported outcomes 2 years postoperatively. Study Design: Cohort study; Level of evidence, 2. Methods: From an ongoing prospective cohort study, 2333 patients who underwent primary isolated ACL reconstruction without collateral or posterior cruciate ligament injury were identified. Patients reported by the operating surgeons as having an International Knee Documentation Committee (IKDC) grade D for Lachman, anterior drawer, or pivot-shift examination were classified as having high-grade laxity. Multiple logistic regression modeling was used to evaluate whether having high-grade preoperative laxity was associated with increased odds of undergoing revision ACL reconstruction within 2 years of the index procedure, controlling for patient age, sex, Marx activity level, level of competition, and graft type. Multiple linear regression modeling was used to evaluate whether having high-grade preoperative laxity was associated with worse IKDC score or Knee injury and Osteoarthritis Outcome Score Knee-Related Quality of Life subscale (KOOS-QOL) scores at a minimum 2 years postoperatively, 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 meniscus status. Results: Pre-reconstruction laxity data were available for 2325 patients (99.7%). Two-year revision data were available for 2259 patients (96.8%), and patient-reported outcomes were available for 1979 patients (84.8%). High-grade preoperative laxity was noted in 743 patients (31.9%). The mean postoperative IKDC score was 81.8 ± 15.9, and the mean KOOS-QOL score was 72.0 ± 22.0. The presence of high-grade pre-reconstruction laxity was associated with significantly increased odds of ACL graft revision (odds ratio [OR] = 1.87 [95% CI, 1.19-2.95]; P =.007). The presence of high-grade pre-reconstruction laxity was not associated with any difference in postoperative IKDC (β = '0.56, P =.44) or KOOS-QOL (β = 0.04, P =.97). Conclusion: The presence of high-grade pre-reconstruction knee laxity as assessed by manual physical examination under anesthesia is associated with significantly increased odds of revision ACL surgery but has no association with patient-reported outcome scores at 2 years after ACL reconstruction.

KW - anterior cruciate ligament

KW - diagnosis

KW - knee laxity

KW - knee ligaments

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