Predictors of Patient-Reported Outcomes at 2 Years After Revision Anterior Cruciate Ligament Reconstruction

The MARS Group

Research output: Contribution to journalArticle

Abstract

Background: Patient-reported outcomes (PROs) are a valid measure of results after revision anterior cruciate ligament (ACL) reconstruction. Revision ACL reconstruction has been documented to have worse outcomes when compared with primary ACL reconstruction. Understanding positive and negative predictors of PROs will allow surgeons to modify and potentially improve outcome for patients. Purpose/Hypothesis: The purpose was to describe PROs after revision ACL reconstruction and test the hypothesis that patient- and technique-specific variables are associated with these outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing revision ACL reconstruction were identified and prospectively enrolled by 83 surgeons over 52 sites. Data included baseline demographics, surgical technique and pathology, and a series of validated PRO instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale. Patients were followed up at 2 years and asked to complete the identical set of outcome instruments. Multivariate regression models were used to control for a variety of demographic and surgical factors to determine the positive and negative predictors of PRO scores at 2 years after revision surgery. Results: A total of 1205 patients met the inclusion criteria and were successfully enrolled: 697 (58%) were male, with a median cohort age of 26 years. The median time since their most recent previous ACL reconstruction was 3.4 years. Two-year questionnaire follow-up was obtained from 989 patients (82%). The most significant positive predictors of 2-year IKDC scores were a high baseline IKDC score, high baseline Marx activity level, male sex, and having a longer time since the most recent previous ACL reconstruction, while negative predictors included having a lateral meniscectomy before the revision ACL reconstruction or having grade 3/4 chondrosis in either the trochlear groove or the medial tibial plateau at the time of the revision surgery. For KOOS, having a high baseline score and having a longer time between the most recent previous ACL reconstruction and revision surgery were significant positive predictors for having a better (ie, higher) 2-year KOOS, while having a lateral meniscectomy before the revision ACL reconstruction was a consistent predictor for having a significantly worse (ie, lower) 2-year KOOS. Statistically significant positive predictors for 2-year Marx activity levels included higher baseline Marx activity levels, younger age, male sex, and being a nonsmoker. Negative 2-year activity level predictors included having an allograft or a biologic enhancement at the time of revision surgery. Conclusion: PROs after revision ACL reconstruction are associated with a variety of patient- and surgeon-related variables. Understanding positive and negative predictors of PROs will allow surgeons to guide patient expectations as well as potentially improve outcomes.

Original languageEnglish (US)
Pages (from-to)2394-2401
Number of pages8
JournalAmerican Journal of Sports Medicine
Volume47
Issue number10
DOIs
StatePublished - Aug 1 2019

Fingerprint

Anterior Cruciate Ligament Reconstruction
Knee Injuries
Knee Osteoarthritis
Reoperation
Documentation
Knee
Patient Reported Outcome Measures
Demography
Surgical Pathology
Ontario
Osteoarthritis
Allografts
Cohort Studies

Keywords

  • ACL reconstruction
  • IKDC
  • KOOS
  • Marx
  • outcomes
  • revision

ASJC Scopus subject areas

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

Cite this

Predictors of Patient-Reported Outcomes at 2 Years After Revision Anterior Cruciate Ligament Reconstruction. / The MARS Group.

In: American Journal of Sports Medicine, Vol. 47, No. 10, 01.08.2019, p. 2394-2401.

Research output: Contribution to journalArticle

@article{12936147bae9407cab17c42ca6906973,
title = "Predictors of Patient-Reported Outcomes at 2 Years After Revision Anterior Cruciate Ligament Reconstruction",
abstract = "Background: Patient-reported outcomes (PROs) are a valid measure of results after revision anterior cruciate ligament (ACL) reconstruction. Revision ACL reconstruction has been documented to have worse outcomes when compared with primary ACL reconstruction. Understanding positive and negative predictors of PROs will allow surgeons to modify and potentially improve outcome for patients. Purpose/Hypothesis: The purpose was to describe PROs after revision ACL reconstruction and test the hypothesis that patient- and technique-specific variables are associated with these outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing revision ACL reconstruction were identified and prospectively enrolled by 83 surgeons over 52 sites. Data included baseline demographics, surgical technique and pathology, and a series of validated PRO instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale. Patients were followed up at 2 years and asked to complete the identical set of outcome instruments. Multivariate regression models were used to control for a variety of demographic and surgical factors to determine the positive and negative predictors of PRO scores at 2 years after revision surgery. Results: A total of 1205 patients met the inclusion criteria and were successfully enrolled: 697 (58{\%}) were male, with a median cohort age of 26 years. The median time since their most recent previous ACL reconstruction was 3.4 years. Two-year questionnaire follow-up was obtained from 989 patients (82{\%}). The most significant positive predictors of 2-year IKDC scores were a high baseline IKDC score, high baseline Marx activity level, male sex, and having a longer time since the most recent previous ACL reconstruction, while negative predictors included having a lateral meniscectomy before the revision ACL reconstruction or having grade 3/4 chondrosis in either the trochlear groove or the medial tibial plateau at the time of the revision surgery. For KOOS, having a high baseline score and having a longer time between the most recent previous ACL reconstruction and revision surgery were significant positive predictors for having a better (ie, higher) 2-year KOOS, while having a lateral meniscectomy before the revision ACL reconstruction was a consistent predictor for having a significantly worse (ie, lower) 2-year KOOS. Statistically significant positive predictors for 2-year Marx activity levels included higher baseline Marx activity levels, younger age, male sex, and being a nonsmoker. Negative 2-year activity level predictors included having an allograft or a biologic enhancement at the time of revision surgery. Conclusion: PROs after revision ACL reconstruction are associated with a variety of patient- and surgeon-related variables. Understanding positive and negative predictors of PROs will allow surgeons to guide patient expectations as well as potentially improve outcomes.",
keywords = "ACL reconstruction, IKDC, KOOS, Marx, outcomes, revision",
author = "{The MARS Group} and Wright, {Rick W.} and Huston, {Laura J.} and Haas, {Amanda K.} and Allen, {Christina R.} and Anderson, {Allen F.} and Cooper, {Daniel E.} and DeBerardino, {Thomas M.} and Dunn, {Warren R.} and Lantz, {Brett (Brick) A.} and Barton Mann and Spindler, {Kurt P.} and Stuart, {Michael J.} and Nwosu, {Samuel K.} and Albright, {John P.} and Amendola, {Annunziato (Ned)} and Andrish, {Jack T.} and Annunziata, {Christopher C.} and Arciero, {Robert A.} and Bach, {Bernard R.} and Baker, {Champ L.} and Bartolozzi, {Arthur R.} and Baumgarten, {Keith M.} and Bechler, {Jeffery R.} and Berg, {Jeffrey H.} and Bernas, {Geoffrey A.} and Brockmeier, {Stephen F.} and Brophy, {Robert H.} and Bush-Joseph, {Charles A.} and {Brad Butler V}, J. and Campbell, {John D.} and Carey, {James L.} and Carpenter, {James E.} and Cole, {Brian J.} and Cooper, {Jonathan M.} and Cox, {Charles L.} and Creighton, {R. Alexander} and Dahm, {Diane L.} and David, {Tal S.} and Flanigan, {David C.} and Frederick, {Robert W.} and Ganley, {Theodore J.} and Garofoli, {Elizabeth A.} and Gatt, {Charles J.} and Gecha, {Steven R.} and Giffin, {James Robert} and Hame, {Sharon L.} and Hannafin, {Jo A.} and Harner, {Christopher D.} and Harris, {Norman Lindsay} and Levy, {Bruce A}",
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TY - JOUR

T1 - Predictors of Patient-Reported Outcomes at 2 Years After Revision Anterior Cruciate Ligament Reconstruction

AU - The MARS Group

AU - Wright, Rick W.

AU - Huston, Laura J.

AU - Haas, Amanda K.

AU - Allen, Christina R.

AU - Anderson, Allen F.

AU - Cooper, Daniel E.

AU - DeBerardino, Thomas M.

AU - Dunn, Warren R.

AU - Lantz, Brett (Brick) A.

AU - Mann, Barton

AU - Spindler, Kurt P.

AU - Stuart, Michael J.

AU - Nwosu, Samuel K.

AU - Albright, John P.

AU - Amendola, Annunziato (Ned)

AU - Andrish, Jack T.

AU - Annunziata, Christopher C.

AU - Arciero, Robert A.

AU - Bach, Bernard R.

AU - Baker, Champ L.

AU - Bartolozzi, Arthur R.

AU - Baumgarten, Keith M.

AU - Bechler, Jeffery R.

AU - Berg, Jeffrey H.

AU - Bernas, Geoffrey A.

AU - Brockmeier, Stephen F.

AU - Brophy, Robert H.

AU - Bush-Joseph, Charles A.

AU - Brad Butler V, J.

AU - Campbell, John D.

AU - Carey, James L.

AU - Carpenter, James E.

AU - Cole, Brian J.

AU - Cooper, Jonathan M.

AU - Cox, Charles L.

AU - Creighton, R. Alexander

AU - Dahm, Diane L.

AU - David, Tal S.

AU - Flanigan, David C.

AU - Frederick, Robert W.

AU - Ganley, Theodore J.

AU - Garofoli, Elizabeth A.

AU - Gatt, Charles J.

AU - Gecha, Steven R.

AU - Giffin, James Robert

AU - Hame, Sharon L.

AU - Hannafin, Jo A.

AU - Harner, Christopher D.

AU - Harris, Norman Lindsay

AU - Levy, Bruce A

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Background: Patient-reported outcomes (PROs) are a valid measure of results after revision anterior cruciate ligament (ACL) reconstruction. Revision ACL reconstruction has been documented to have worse outcomes when compared with primary ACL reconstruction. Understanding positive and negative predictors of PROs will allow surgeons to modify and potentially improve outcome for patients. Purpose/Hypothesis: The purpose was to describe PROs after revision ACL reconstruction and test the hypothesis that patient- and technique-specific variables are associated with these outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing revision ACL reconstruction were identified and prospectively enrolled by 83 surgeons over 52 sites. Data included baseline demographics, surgical technique and pathology, and a series of validated PRO instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale. Patients were followed up at 2 years and asked to complete the identical set of outcome instruments. Multivariate regression models were used to control for a variety of demographic and surgical factors to determine the positive and negative predictors of PRO scores at 2 years after revision surgery. Results: A total of 1205 patients met the inclusion criteria and were successfully enrolled: 697 (58%) were male, with a median cohort age of 26 years. The median time since their most recent previous ACL reconstruction was 3.4 years. Two-year questionnaire follow-up was obtained from 989 patients (82%). The most significant positive predictors of 2-year IKDC scores were a high baseline IKDC score, high baseline Marx activity level, male sex, and having a longer time since the most recent previous ACL reconstruction, while negative predictors included having a lateral meniscectomy before the revision ACL reconstruction or having grade 3/4 chondrosis in either the trochlear groove or the medial tibial plateau at the time of the revision surgery. For KOOS, having a high baseline score and having a longer time between the most recent previous ACL reconstruction and revision surgery were significant positive predictors for having a better (ie, higher) 2-year KOOS, while having a lateral meniscectomy before the revision ACL reconstruction was a consistent predictor for having a significantly worse (ie, lower) 2-year KOOS. Statistically significant positive predictors for 2-year Marx activity levels included higher baseline Marx activity levels, younger age, male sex, and being a nonsmoker. Negative 2-year activity level predictors included having an allograft or a biologic enhancement at the time of revision surgery. Conclusion: PROs after revision ACL reconstruction are associated with a variety of patient- and surgeon-related variables. Understanding positive and negative predictors of PROs will allow surgeons to guide patient expectations as well as potentially improve outcomes.

AB - Background: Patient-reported outcomes (PROs) are a valid measure of results after revision anterior cruciate ligament (ACL) reconstruction. Revision ACL reconstruction has been documented to have worse outcomes when compared with primary ACL reconstruction. Understanding positive and negative predictors of PROs will allow surgeons to modify and potentially improve outcome for patients. Purpose/Hypothesis: The purpose was to describe PROs after revision ACL reconstruction and test the hypothesis that patient- and technique-specific variables are associated with these outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing revision ACL reconstruction were identified and prospectively enrolled by 83 surgeons over 52 sites. Data included baseline demographics, surgical technique and pathology, and a series of validated PRO instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale. Patients were followed up at 2 years and asked to complete the identical set of outcome instruments. Multivariate regression models were used to control for a variety of demographic and surgical factors to determine the positive and negative predictors of PRO scores at 2 years after revision surgery. Results: A total of 1205 patients met the inclusion criteria and were successfully enrolled: 697 (58%) were male, with a median cohort age of 26 years. The median time since their most recent previous ACL reconstruction was 3.4 years. Two-year questionnaire follow-up was obtained from 989 patients (82%). The most significant positive predictors of 2-year IKDC scores were a high baseline IKDC score, high baseline Marx activity level, male sex, and having a longer time since the most recent previous ACL reconstruction, while negative predictors included having a lateral meniscectomy before the revision ACL reconstruction or having grade 3/4 chondrosis in either the trochlear groove or the medial tibial plateau at the time of the revision surgery. For KOOS, having a high baseline score and having a longer time between the most recent previous ACL reconstruction and revision surgery were significant positive predictors for having a better (ie, higher) 2-year KOOS, while having a lateral meniscectomy before the revision ACL reconstruction was a consistent predictor for having a significantly worse (ie, lower) 2-year KOOS. Statistically significant positive predictors for 2-year Marx activity levels included higher baseline Marx activity levels, younger age, male sex, and being a nonsmoker. Negative 2-year activity level predictors included having an allograft or a biologic enhancement at the time of revision surgery. Conclusion: PROs after revision ACL reconstruction are associated with a variety of patient- and surgeon-related variables. Understanding positive and negative predictors of PROs will allow surgeons to guide patient expectations as well as potentially improve outcomes.

KW - ACL reconstruction

KW - IKDC

KW - KOOS

KW - Marx

KW - outcomes

KW - revision

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U2 - 10.1177/0363546519862279

DO - 10.1177/0363546519862279

M3 - Article

VL - 47

SP - 2394

EP - 2401

JO - American Journal of Sports Medicine

JF - American Journal of Sports Medicine

SN - 0363-5465

IS - 10

ER -