Abstract
PurposeTo analyze minimal important change (MIC), patient-acceptable symptom state (PASS) and treatment failure after reoperation within 2 years of primary ACL reconstruction and compare them with patients without additional surgery.MethodsThis is a retrospective follow-up study of a cohort from a single-clinic database with all primary ACLRs enrolled between 2005 and 2015. Additional surgery within 2 years of the primary ACLR on the ipsilateral knee was identified using procedural codes and analysis of medical records. Patients who completed the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire preoperatively and at the 2-year follow-up were included in the study. MIC, PASS and treatment failure thresholds were applied using the aggregate KOOS (KOOS4) and the five KOOS subscales.ResultsThe cohort included 6030 primary ACLR and from this 1112 (18.4%) subsequent surgeries were performed on 1018 (16.9%) primary ACLRs. 24 months follow-up for KOOS was obtained on 523 patients (54%) in the reoperation group and 2084 (44%) in the no-reoperation group. MIC; the no-reoperation group had a significantly higher improvement on all KOOS subscales, Pain 70.3 vs 60.2% (p < 0.01), Symptoms 72.1 vs 57.4% (p < 0.01), ADL 56.3 vs 51.2% (p < 0.01), Sport/Rec 67.3 vs 54.4% (p < 0.01), QoL 73.9 vs 56.3% (p < 0.01). PASS; 62% in the non-reoperation group reported their KOOS4 scores to be satisfactory, while only 35% reported satisfactory results in the reoperated cohort (p < 0.05). Treatment failure; 2% in the non-reoperation group and 6% (p < 0.05) in the reoperation group considered their treatment to have failed.ConclusionPatients who underwent subsequent surgeries within 2 years of primary ACLR reported significantly inferior outcomes in MIC, PASS and treatment failure compared to the non-reoperated counterpart at the 2-year follow-up. This study provides clinicians with important information and knowledge about the outcomes after an ACLR with subsequent additional surgery.Level of evidenceIII.
Highlights
Rupture of the anterior cruciate ligament (ACL) is a common injury and the rates of ACL reconstructions (ACLR) among young adults increased in recent years [22, 23, 25]
Two-year follow-up for Knee injury and Osteoarthritis Outcome Score (KOOS) was obtained for 448 patients (44%) in the reoperation group and 2084 (44%) in the no-reoperation group (Fig. 1)
The overwhelming majority of ACLR were done with HT grafts and no difference could be seen between BPTB and HT at risk for reoperations in general, Table 1, due to few patients, we were not able to do further subgroup analysis
Summary
Rupture of the anterior cruciate ligament (ACL) is a common injury and the rates of ACL reconstructions (ACLR) among young adults increased in recent years [22, 23, 25]. The primary goal of an ACLR is to restore knee laxity and improve. To better transfer the data to something that can be interpreted as a clinically relevant improvement or an acceptable result, three definitions are widely used; minimal important change (MIC), patient-acceptable symptom state (PASS) and treatment failure. The MIC is the smallest change in KOOS subscale scores that is considered to be clinically relevant [6]. Ingelsrud et al [13] recently defined subscale-specific cut-offs for the MIC after an ACLR. The PASS answers the question if the patient considers his/her knee function satisfactory and tries to identify the patients that consider themselves to be well. Muller et al [17] validated the thresholds for the achievement of a PASS for each KOOS subscale. MIC and PASS together complement each other and identify patients feeling better, i.e., achieving the MIC threshold, and feeling good, i.e., achieving the PASS thresholds
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