The effect of patient and injury factors on long-term outcome after anterior cruciate ligament reconstruction

Background: Long-term follow-up is required for accurate assessment of results after anterior cruciate ligament (ACL) reconstruction and recent years have witnessed the publication of numerous papers detailing long-term outcomes. The primary aim of this systematic review was to determine which patient factors affect long-term clinical and radiographic outcomes based on the current literature.

Methods: A comprehensive literature review yielded 18 prospective manuscripts with minimum follow-up ranging from 5-12 years after ACL reconstruction.

Results: Longer follow-up was associated with increased radiographic evidence of osteoarthritis. Increased meniscal or articular cartilage pathology at ACL reconstruction were found to be associated with increased prevalence of radiographic evidence of osteoarthritis at long-term follow-up in most studies. There is currently insufficient evidence to correlate these intra-articular findings with decreases in clinical outcome measures. Further research is needed to determine the effect of body mass index (BMI) on long-term outcome after ACL reconstruction.

Conclusions: Intra-articular injuries noted at the time of ACL reconstruction affect long-term results. The effect of BMI and other patient factors is unclear. Long-term follow-up of large multicenter cohorts will provide definitive data on the relative importance of different factors in determining results of ACL reconstruction.