TY - JOUR
T1 - Neither Residual Anterior Knee Laxity Up to 6 mm nor a Pivot Glide Predict Patient-Reported Outcome Scores or Subsequent Knee Surgery Between 2 and 6 Years After ACL Reconstruction
AU - MOON Knee Group
AU - Magnussen, Robert A.
AU - Reinke, Emily K.
AU - Huston, Laura J.
AU - Briskin, Isaac
AU - Cox, Charles L.
AU - Dunn, Warren R.
AU - Flanigan, David C.
AU - Jones, Morgan H.
AU - Kaeding, Christopher C.
AU - Matava, Matthew J.
AU - Parker, Richard D.
AU - Smith, Matthew V.
AU - Wright, Rick W.
AU - Spindler, Kurt P.
N1 - Funding Information:
Research reported in this publication was partially supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number R01 AR053684 (K.P.S.), grant No. K23 AR063767 (R.A.M.), and under award number K23 AR066133, which supported a portion of M.H.J.’s professional effort.
Funding Information:
One or more of the authors has declared the following potential conflict of interest or source of funding: This study was funded by NIH R01 AR053684 (K.P.S., PI), Clinical and Translational Science Award No. UL1 TR002243, and unrestricted research grants from Smith & Nephew Endoscopy and DonJoy Orthopaedics. R.A.M. has received research funding from Zimmer and Arthrex and education support from CDC Medical. W.R.D. has received hospitality payments from Encore Medical and Wright Medical Technology and speaking fees from Linvatec Corp. D.C.F. has received consulting fees from Smith & Nephew, Mitek, Conmed, MTF, Vericel, Zimmer Biomet, Moximed, KCRN, Hyalex, Linvatec, Ceterix, DePuy Synthes, Medical Device Business, DePuy Orthopaedics, and Aastrom Biosciences; educational support from CDC Medical; and fees for services other than consulting from Pacira. C.C.K. has received consulting fees from Zimmer Biomet and hospitality payments from DJO, Arthrex, and Smith & Nephew. M.J.M. has received consulting fees from Arthrex, Schwartz, Pacira, and Heron Therapeutics and educational support from BREG and Elite Orthopedics. R.D.P. has received royalties from Zimmer Biomet and hospitality payments from Zimmer Biomet, Smith & Nephew, and Musculoskeletal Transplant Therapeutics. M.V.S. has received educational support from Elite Orthopedics and Arthrex. R.W.W. has received royalties from and holds stock in Responsive Arthroscopy. K.P.S. has received consulting fees from Flexion Therapeutics, Novopeds, and the National Football League and research funding from Smith & Nephew Endoscopy and DonJoy Orthopaedics. M.H.J. is on the scientific advisory board for Samumed. C.L.C. has a sibling who works for Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Funding Information:
The authors thank the research coordinators, analysts, and support staff from the Multicenter Orthopaedic Outcomes Network (MOON) sites, whose efforts related to regulatory requirements, data collection, patient follow-up, data quality control, analyses, and manuscript preparation have made this consortium successful. Thank you to Brittany Stojsavljevic, editorial assistant, Cleveland Clinic Foundation, for editorial management. The authors also thank all individuals who generously enrolled and participated in the study.
Publisher Copyright:
© 2021 The Author(s).
PY - 2021/8
Y1 - 2021/8
N2 - 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.
AB - 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.
KW - anterior cruciate ligament
KW - knee laxity
KW - patient-reported outcomes
KW - reconstruction
UR - http://www.scopus.com/inward/record.url?scp=85110587560&partnerID=8YFLogxK
U2 - 10.1177/03635465211025003
DO - 10.1177/03635465211025003
M3 - Article
C2 - 34269610
AN - SCOPUS:85110587560
SN - 0363-5465
VL - 49
SP - 2631
EP - 2637
JO - American Journal of Sports Medicine
JF - American Journal of Sports Medicine
IS - 10
ER -