Outcomes of anterior cruciate ligament reconstruction in patients with workers' compensation claims

Abstract

A general perception exists that outcomes of orthopaedic procedures in patient's with Worker's Compensation claims fare worse than those of patients without such claims. We retrospectively reviewed the outcomes of anterior cruciate ligament (ACL) reconstruction in patients who have Workers' Compensation claims. This minimum 2-year follow-up study analyzed the occupational, functional, and objective results of patients who underwent arthroscopic-assisted anterior cruciate ligament (ACL) reconstruction. Twenty-two patients with Workers' Compensation claims representing 5% of patients who underwent ACL reconstruction at our institution between 1987 and 1995 were included in the current study. All reconstructions were performed by the senior author (B.R.B.) using arthroscopic-assisted techniques (single and double-incision) with bone-patellar tendon-bone autografts followed by an accelerated rehabilitation protocol. Postoperative follow-up physical examination revealed a negative anterior drawer in 19 patients (91%), a negative Lachman in 15 patients (68%), and a negative pivot shift in 21 patients (96%). The KT-1000 arthrometric evaluation at follow-up showed a mean maximum manual difference of 1.9 mm with 15 patients (68%) having a maximum manual difference of ≤3 mm and 7 patients (32%) from 3 to 5 mm. The mean postoperative scores for the Hospital for Special Surgery scoring scale was 86, Noyes Sports activity scale 81, Noyes ADL score 36, Noyes Problem with Sports 75, Noyes Sports Function score 87, Lysholm score 82, and the Tegner score 5.9. The Noyes Occupational rating system increased from preoperative 48 to 60 postoperatively and the Noyes Job Title rating system score remained at 5 after surgery. Functional testing revealed mean deficits of no more than 9% between the reconstructed and normal knees. SF-36 testing revealed significantly higher scores in the Role Physical and General Health categories and significantly lower score in the Mental Health category when compared with United States norms. Subjective evaluation revealed that 95% of the patients would undergo a similar procedure if faced with a similar injury to the contralateral knee in the future. The results of the current study show that ACL reconstruction leads to predictable functional and occupational results in those patients with work-related injuries. All of our patients were able to return to work. The hypothesis that Workers' Compensation compromises the results of ACL reconstruction was not observed in this study.