Robert A Magnussen1,2, Emily K Reinke3,2, Laura J Huston4,2, Isaac Briskin5,2, Charles L Cox6,2, Warren R Dunn7,2, David C Flanigan8,2, Morgan H Jones5,2, Christopher C Kaeding8,2, Matthew J Matava9,2, Richard D Parker5,2, Matthew V Smith9,2, Rick W Wright6,2, Kurt P Spindler10,2. 1. Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA. 2. Investigation performed at The Ohio State University, Columbus, Ohio, USA; the Vanderbilt University Medical Center, Nashville, Tennessee, USA; and the Cleveland Clinic, Cleveland, Ohio, USA. 3. Sports Medicine, Orthopaedic Surgery Research, Duke University Medical Center, Duke Sports Science Institute, Durham, North Carolina, USA. 4. Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 5. Cleveland Clinic, Cleveland, Ohio, USA. 6. Vanderbilt University Medical Center, Nashville, Tennessee, USA. 7. Texas Orthopedic Hospital, Houston, Texas, USA. 8. The Ohio State University, Columbus, Ohio, USA. 9. Washington University, St. Louis, Missouri, USA. 10. Department of Orthopaedics, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Abstract
BACKGROUND: A primary goal of anterior cruciate ligament reconstruction (ACLR) is to reduce pathologically increased anterior and rotational laxity of the knee, but the effects of residual laxity on patient-reported outcomes (PROs) after ACLR remain unclear. HYPOTHESIS: Increased residual laxity at 2 years postoperatively is predictive of a higher risk of subsequent ipsilateral knee surgery and decreases in PRO scores from 2 to 6 years after surgery. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: From a prospective multicenter cohort, 433 patients aged <36 years were identified at a minimum 2 years after primary ACLR. These patients underwent a KT-1000 arthrometer assessment and pivot-shift test and completed PRO assessments with the Knee injury and Osteoarthritis Outcome Score and International Knee Documentation Committee (IKDC) scores. Patients completed the same PROs at 6 years postoperatively, and any subsequent ipsilateral knee procedures during this period were recorded. Subsequent surgery risk and change in PROs from 2 to 6 years postoperatively were compared based on residual side-to-side KT-1000 arthrometer differences (<-1 mm, -1 to 2 mm, 2 to 6 mm, and >6 mm) in laxity at 2 years postoperatively. Multiple linear regression models were built to determine the relationship between 2-year postoperative knee laxity and 2- to 6-year change in PROs while controlling for age, sex, body mass index, smoking status, meniscal and cartilage status, and graft type. RESULTS: A total of 381 patients (87.9%) were available for follow-up 6 years postoperatively. There were no significant differences in risk of subsequent knee surgery based on residual knee laxity. Patients with a difference >6 mm in side-to-side anterior laxity at 2 years postoperatively were noted to have a larger decrease in PROs from 2 to 6 years postoperatively (P < .05). No significant differences in any PROs were noted among patients with a difference <6 mm in side-to-side anterior laxity or those with pivot glide (IKDC B) versus no pivot shift (IKDC A). CONCLUSION: The presence of a residual side-to-side KT-1000 arthrometer difference <6 mm or pivot glide at 2 years after ACLR is not associated with an increased risk of subsequent ipsilateral knee surgery or decreased PROs up to 6 years after ACLR. Conversely, patients exhibiting a difference >6 mm in side-to-side anterior laxity were noted to have significantly decreased PROs at 6 years after ACLR.
BACKGROUND: A primary goal of anterior cruciate ligament reconstruction (ACLR) is to reduce pathologically increased anterior and rotational laxity of the knee, but the effects of residual laxity on patient-reported outcomes (PROs) after ACLR remain unclear. HYPOTHESIS: Increased residual laxity at 2 years postoperatively is predictive of a higher risk of subsequent ipsilateral knee surgery and decreases in PRO scores from 2 to 6 years after surgery. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: From a prospective multicenter cohort, 433 patients aged <36 years were identified at a minimum 2 years after primary ACLR. These patients underwent a KT-1000 arthrometer assessment and pivot-shift test and completed PRO assessments with the Knee injury and Osteoarthritis Outcome Score and International Knee Documentation Committee (IKDC) scores. Patients completed the same PROs at 6 years postoperatively, and any subsequent ipsilateral knee procedures during this period were recorded. Subsequent surgery risk and change in PROs from 2 to 6 years postoperatively were compared based on residual side-to-side KT-1000 arthrometer differences (<-1 mm, -1 to 2 mm, 2 to 6 mm, and >6 mm) in laxity at 2 years postoperatively. Multiple linear regression models were built to determine the relationship between 2-year postoperative knee laxity and 2- to 6-year change in PROs while controlling for age, sex, body mass index, smoking status, meniscal and cartilage status, and graft type. RESULTS: A total of 381 patients (87.9%) were available for follow-up 6 years postoperatively. There were no significant differences in risk of subsequent knee surgery based on residual knee laxity. Patients with a difference >6 mm in side-to-side anterior laxity at 2 years postoperatively were noted to have a larger decrease in PROs from 2 to 6 years postoperatively (P < .05). No significant differences in any PROs were noted among patients with a difference <6 mm in side-to-side anterior laxity or those with pivot glide (IKDC B) versus no pivot shift (IKDC A). CONCLUSION: The presence of a residual side-to-side KT-1000 arthrometer difference <6 mm or pivot glide at 2 years after ACLR is not associated with an increased risk of subsequent ipsilateral knee surgery or decreased PROs up to 6 years after ACLR. Conversely, patients exhibiting a difference >6 mm in side-to-side anterior laxity were noted to have significantly decreased PROs at 6 years after ACLR.
Authors: Mininder S Kocher; J Richard Steadman; Karen K Briggs; William I Sterett; Richard J Hawkins Journal: Am J Sports Med Date: 2004 Apr-May Impact factor: 6.202
Authors: Robert G Marx; Jason Connor; Stephen Lyman; Annunziato Amendola; Jack T Andrish; Christopher Kaeding; Eric C McCarty; Richard D Parker; Rick W Wright; Kurt P Spindler Journal: Am J Sports Med Date: 2005-08-10 Impact factor: 6.202
Authors: Robert Magnussen; Emily K Reinke; Laura J Huston; Jack T Andrish; Charles L Cox; Warren R Dunn; David C Flanigan; Timothy Hewett; Morgan H Jones; Christopher C Kaeding; Dawn Lorring; Matthew J Matava; Richard D Parker; Angela Pedroza; Emily Preston; Brian Richardson; Bettina Schroeder; Matthew V Smith; Rick W Wright; Kurt P Spindler Journal: Am J Sports Med Date: 2019-07 Impact factor: 6.202
Authors: A G Culvenor; L Perraton; A Guermazi; A L Bryant; T S Whitehead; H G Morris; K M Crossley Journal: Osteoarthritis Cartilage Date: 2016-05-14 Impact factor: 6.576
Authors: Justin W Arner; James N Irvine; Liying Zheng; Tom Gale; Eric Thorhauer; Margaret Hankins; Ermias Abebe; Scott Tashman; Xudong Zhang; Christopher D Harner Journal: Orthop J Sports Med Date: 2016-04-01