TY - JOUR
T1 - Rehabilitation predictors of clinical outcome following revision ACL reconstruction in the MARS cohort
AU - MARS Group
AU - Wright, Rick W.
AU - Huston, Laura J.
AU - Nwosu, Samuel K.
AU - Allen, Christina R.
AU - Anderson, Allen F.
AU - Cooper, Daniel E.
AU - DeBerardino, Thomas M.
AU - Dunn, Warren R.
AU - Haas, Amanda K.
AU - Lantz, Brett (Brick) A.
AU - Mann, Barton
AU - Spindler, Kurt P.
AU - Stuart, Michael J.
AU - Albright, John P.
AU - Amendola, Annunziato (Ned)
AU - Andrish, Jack T.
AU - Annunziata, Christopher C.
AU - Arciero, Robert A.
AU - Bach, Bernard R.
AU - Baker, Champ L.
AU - Bartolozzi, Arthur R.
AU - Baumgarten, Keith M.
AU - Bechler, Jeffery R.
AU - Berg, Jeffrey H.
AU - Bernas, Geoffrey A.
AU - Brockmeier, Stephen F.
AU - Brophy, Robert H.
AU - Bush-Joseph, Charles A.
AU - Butler, J. Brad
AU - Campbell, John D.
AU - Carey, James L.
AU - Carpenter, James E.
AU - Cole, Brian J.
AU - Cooper, Jonathan M.
AU - Cox, Charles L.
AU - Creighton, R. Alexander
AU - Dahm, Diane L.
AU - David, Tal S.
AU - Flanigan, David C.
AU - Frederick, Robert W.
AU - Ganley, Theodore J.
AU - Garofoli, Elizabeth A.
AU - Gatt, Charles J.
AU - Gecha, Steven R.
AU - Giffin, James Robert
AU - Hame, Sharon L.
AU - Hannafin, Jo A.
AU - Harner, Christopher D.
AU - Matava, Matthew J.
AU - Smith, Matthew V.
N1 - Publisher Copyright:
© 2019 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Background:Revision anterior cruciate ligament (ACL) reconstruction has been documented to have worse outcomes than primary ACL reconstruction. The reasons remain varied and not completely understood.Methods:Patients undergoing revision ACL reconstruction were prospectively enrolled. Data collected included baseline demographics, surgical technique and pathological condition, prescribed rehabilitation instructions, and a series of validated patient-reported outcome instruments. Patients were followed for 2 years and asked to complete a set of outcome instruments identical to those completed at baseline. Subsequent surgical procedures on the ipsilateral knee were recorded. Regression analysis was used to control for age, sex, activity level, baseline outcome scores, and the above-mentioned rehabilitation-related variables in order to assess the factors affecting clinical outcomes 2 years after revision ACL reconstruction.Results:A total of 843 patients met the inclusion criteria and were successfully enrolled, and 82% (695) were followed for 2 years. Two rehabilitation-related factors were found to influence outcome. First, patients who were prescribed an ACL brace for their return to sports had a significantly better Knee injury and Osteoarthritis Outcome Score (KOOS) for sports and recreational activities at 2 years (odds ratio [OR] =1.50, 95% confidence interval [CI] = 1.07 to 2.11; p = 0.019). Second, patients prescribed an ACL brace for the postoperative rehabilitation period were 2.3 times more likely to have subsequent surgery by 2 years (OR = 2.26, 95% CI = 1.11 to 4.60; p = 0.024). The odds of a graft rerupture were not affected by any type of brace wear.Conclusions:Rehabilitation-related factors that the physician can control at the time of an ACL reconstruction have the ability to influence clinical outcomes at 2 years. Weight-bearing and motion can be initiated immediately postoperatively. Bracing during the early postoperative period is not helpful. Use of a functional brace early in the postoperative period was associated with an increased risk of a reoperation. Use of a functional brace for a return to sports improved the KOOS on the sports/recreation subscale.Level of Evidence:Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
AB - Background:Revision anterior cruciate ligament (ACL) reconstruction has been documented to have worse outcomes than primary ACL reconstruction. The reasons remain varied and not completely understood.Methods:Patients undergoing revision ACL reconstruction were prospectively enrolled. Data collected included baseline demographics, surgical technique and pathological condition, prescribed rehabilitation instructions, and a series of validated patient-reported outcome instruments. Patients were followed for 2 years and asked to complete a set of outcome instruments identical to those completed at baseline. Subsequent surgical procedures on the ipsilateral knee were recorded. Regression analysis was used to control for age, sex, activity level, baseline outcome scores, and the above-mentioned rehabilitation-related variables in order to assess the factors affecting clinical outcomes 2 years after revision ACL reconstruction.Results:A total of 843 patients met the inclusion criteria and were successfully enrolled, and 82% (695) were followed for 2 years. Two rehabilitation-related factors were found to influence outcome. First, patients who were prescribed an ACL brace for their return to sports had a significantly better Knee injury and Osteoarthritis Outcome Score (KOOS) for sports and recreational activities at 2 years (odds ratio [OR] =1.50, 95% confidence interval [CI] = 1.07 to 2.11; p = 0.019). Second, patients prescribed an ACL brace for the postoperative rehabilitation period were 2.3 times more likely to have subsequent surgery by 2 years (OR = 2.26, 95% CI = 1.11 to 4.60; p = 0.024). The odds of a graft rerupture were not affected by any type of brace wear.Conclusions:Rehabilitation-related factors that the physician can control at the time of an ACL reconstruction have the ability to influence clinical outcomes at 2 years. Weight-bearing and motion can be initiated immediately postoperatively. Bracing during the early postoperative period is not helpful. Use of a functional brace early in the postoperative period was associated with an increased risk of a reoperation. Use of a functional brace for a return to sports improved the KOOS on the sports/recreation subscale.Level of Evidence:Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
UR - http://www.scopus.com/inward/record.url?scp=85065528369&partnerID=8YFLogxK
U2 - 10.2106/JBJS.18.00397
DO - 10.2106/JBJS.18.00397
M3 - Article
C2 - 31045665
AN - SCOPUS:85065528369
SN - 0021-9355
VL - 101
SP - 779
EP - 786
JO - Journal of Bone and Joint Surgery
JF - Journal of Bone and Joint Surgery
IS - 9
ER -