Outcome of chronic isolated anterior cruciate ligament reconstruction

Abstract

The aim of the article is to identify demographic and intraoperative factors that predict patient-oriented outcomes as measured by knee-specific and general quality of life (QoL) questionnaires for chronic, unilateral primary anterior cruciate ligament (ACL) tears following surgical reconstruction. A total of 69 patients were prospectively evaluated using the Medical Outcomes Study 36-item Short Form (SF-36), modified Lysholm, Tegner activity level, and subjective portion of the International Knee Documentation Committee (IKDC) questionnaires. The surveys were administered preoperatively and postoperatively with a minimum 2-year follow up. Efficacy of treatment was evaluated by comparing preoperative and postoperative questionnaire scores. Multivariate linear regression analysis was used to identify demographic and intraoperative variables that were independent predictors of outcome. At a minimum 2-year follow-up (mean, 3.6 years), 55 of 69 patients (80%) were available for follow-up. There were statistically significant improvements in the Lysholm, Tegner, and subjective portion of the IKDC, as well as several SF-36 domains that measure physical capabilities (p < 0.001) . Increasingly, severe patellofemoral and medial compartment articular cartilage damage was associated with lower physical function (PF) (p = 0.009 and 0.005, respectively) and physical component (p = 0.041 and 0.033, respectively) scores on the SF-36. Medial compartment articular cartilage damage and the presence of a lateral meniscus tear were independent predictors of lower bodily pain (BP) scores on the SF-36 (p = 0.007 and 0.010, respectively). QoL and knee function were improved following ACL reconstruction for chronic ACL tears. Independent predictors of poorer outcome were identified in the PF, bodily pain, and physical component score (PCS) of the SF-36. Increasingly, severe articular cartilage injury to the medial and patellofemoral compartments, as well as the presence of a lateral meniscal tear were predictive of poorer outcomes.