Differences in Baseline Characteristics and Outcome Among Responders, Late Responders, and Never-Responders After Anterior Cruciate Ligament Reconstruction

Randsborg, Per-Henrik; Adamec, Dakota; Cepeda, Nicholas A; Pearle, Andrew D.; Ranawat, Anil S.

doi:10.1177/03635465211047858

Cited by 6 publications

(10 citation statements)

References 28 publications

(28 reference statements)

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“…In addition to young age and smoking, previous studies of non-respondents also reported a predominance of the male gender, living alone, and higher preoperative disability at baseline (2,(4)(5)(6)(17)(18)(19). However, these ndings were not reproduced in our study.…”

Section: Discussioncontrasting

confidence: 88%

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Characteristics and outcomes of patients who did not respond to a national spine surgery registry.

Kaur

Alhaug

Dolatowski

et al. 2022

Preprint

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Background Loss to follow-up may bias outcome assessments in medical registries. This cohort study aimed to analyze and compare patients who failed to respond with those that responded to the Norwegian spine surgery register (NORspine). Methods We analyzed a cohort of 474 consecutive patients operated for lumbar spinal stenosis at four public hospitals in Norway during a two-year period. These patients reported sociodemographic data, preoperative symptoms, and Oswestry Disability Index (ODI), numerical rating scales (NRS) for back and leg pain to NORspine at baseline and at 3 and 12 months postoperatively. At a median of 50 (36–64) months after surgery, we contacted all patients who did not respond to NORspine after 12 months. Those who responded were termed responsive non-respondents and compared to 12 months respondents. Results 123 (27%) of patients did not respond to NORspine 12 months after surgery, and 64 (52%) of those responded to our renewed survey at a median of 50 (36–64) months after surgery. At baseline, non-respondents were younger 63 (SD 11.7) vs 68 (SD 9.9) years, mean difference (95% CI) 4.7 years (2.6 to 6.7); p = < 0.001. Non-respondents were more frequently smokers 41 (30%) vs 70 (21%) RR (95%CI) = 1.40 (1.01 to 1.95); p = 0.044. There were no other relevant differences in other sociodemographic variables or preoperative symptoms. We found no differences in effect of surgery on non-respondents vs respondents (ODI (SD) = 28.2 (19.9) vs 25.2 (18.9), MD (95%CI) = 3.0 ( -2.1 to 8.1); p = 0.250. Conclusion We found that 27% of patients did not respond to NORspine 12 months after surgery for lumbar spinal stenosis. Non-respondents were somewhat younger and more frequently smokers. However, responsive non-respondents reported similar clinical outcomes compared to those who responded.

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Section: Discussioncontrasting

confidence: 88%

“…Several studies have demonstrated that non-respondents are younger than respondents (2,4,(17)(18)(19). Completing and posting questionnaires consumes time, and younger patients may be more busy due to work and family obligations.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of patients who did not respond to a national spine surgery registry.

Kaur

Alhaug

Dolatowski

et al. 2022

Preprint

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“…However, we have conducted an in-depth analysis of nonresponders and have not found significant differences in outcome or revision rates between responders and nonresponders. 26 Furthermore, cartilage lesions were assessed only by size, not depth, and our study did not have enough power to analyze the effect of the location in the knee joint of the cartilage lesions.…”

Section: Discussionmentioning

confidence: 98%

Patient-Reported Outcome, Return to Sport, and Revision Rates 7-9 Years After Anterior Cruciate Ligament Reconstruction: Results From a Cohort of 2042 Patients

et al. 2022

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Background: Long-term patient-reported outcome measures (PROMs), rates of return to sport, and revision risk after anterior cruciate ligament (ACL) reconstruction (ACLR) are not well understood. Purpose: To provide long-term follow-up of PROMs, return-to-sport rates, and revision rates after ACLR and to identify predictors for poor outcome. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 2042 patients were included in an institutional ACL registry (2009-2013) and longitudinally followed. PROMs were completed preoperatively and at all follow-up time points. Questions regarding return to sport and knee stability were completed at final follow-up. Predictors for poor outcome on the International Knee Documentation Committee (IKDC) score were estimated in a regression model incorporating risk factors such as patient characteristics, graft choice, and concomitant injuries. Revision rates and risk of subsequent non-ACL surgeries were calculated. Results: Autografts were used in 76% of the patients (patellar tendon, 62%; hamstring grafts, 38%). Allografts were used in 24% of patients. The questionnaires were returned by 1045 (51.2%) patients at a mean of 7.2 years (range, 5.0-9.8 years) after surgery. Improvements in IKDC score of >30 points were sustained for all patient categories. The strongest predictor for lesser improvement in IKDC score was a cartilage lesion >2 cm2 identified during surgery. Male sex and college education completion were associated with improved IKDC scores. Meniscal lesions did not predict change) in the IKDC score. A total of 69% of patients had returned to sport after 8.1 years (range, 6.7-9.8 years). The main reason for not returning to sport was fear of reinjury. The revision rate was 7.2% after 9 years (range, 8-11 years), 13% of patients needed subsequent ipsilateral non-ACL surgery, and 6% underwent contralateral ACLR. The absence of a meniscal tear, younger age, and male sex were predictors for revision. Graft choice did not predict PROM results or revision risk. Conclusion: Improvements in IKDC scores were sustained 7 years after ACLR. The strongest predictor for poor outcome was a cartilage lesion >2 cm2. Patients can expect a 70% return-to-sport rate and an 87% chance of their knee feeling stable during daily and athletic activities after 8 years. Young male patients have better PROM scores but a higher risk of revision. There is a 26% chance of subsequent knee surgery within 9 years, including a revision rate of 7%, subsequent non-ACL surgery to the operated knee in 13%, and a 6% chance of contralateral ACLR.

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“…Several studies have demonstrated that non-respondents are younger than respondents [ 2 , 4 , 16 – 19 ]. Completing and posting questionnaires consumes time, and younger patients may be busier due to work and family obligations.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to young age and smoking, previous studies of non-respondents also reported a predominance of the male gender, living alone, higher anxiety levels, and worse PROM scores [ 2 , 4 – 6 , 16 – 19 ]. Two observational spine studies found that non-respondents had higher ODI scores, lower quality of life (EuroQol 5D), and lower function (Short form health survey—SF-36) preoperatively compared to those who responded [ 2 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of patients who did not respond to a national spine surgery registry

Kaur

Alhaug

Dolatowski

et al. 2023

BMC Musculoskelet Disord

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Background Loss to follow-up may bias outcome assessments in medical registries. This cohort study aimed to analyze and compare patients who failed to respond with those that responded to the Norwegian Registry for Spine Surgery (NORspine). Methods We analyzed a cohort of 474 consecutive patients operated for lumbar spinal stenosis at four public hospitals in Norway during a two-year period. These patients reported sociodemographic data, preoperative symptoms, and Oswestry Disability Index (ODI), numerical rating scales (NRS) for back and leg pain to NORspine at baseline and 12 months postoperatively. We contacted all patients who did not respond to NORspine after 12 months. Those who responded were termed responsive non-respondents and compared to 12 months respondents. Results One hundred forty (30%) did not respond to NORspine 12 months after surgery and 123 were available for additional follow-up. Sixty-four of the 123 non-respondents (52%) responded to a cross-sectional survey done at a median of 50 (36–64) months after surgery. At baseline, non-respondents were younger 63 (SD 11.7) vs. 68 (SD 9.9) years (mean difference (95% CI) 4.7 years (2.6 to 6.7); p = < 0.001) and more frequently smokers 41 (30%) vs. 70 (21%) RR (95%CI) = 1.40 (1.01 to 1.95); p = 0.044. There were no other relevant differences in other sociodemographic variables or preoperative symptoms. We found no differences in the effect of surgery on non-respondents vs. respondents (ODI (SD) = 28.2 (19.9) vs. 25.2 (18.9), MD (95%CI) = 3.0 ( -2.1 to 8.1); p = 0.250). Conclusion We found that 30% of patients did not respond to NORspine at 12 months after spine surgery. Non-respondents were somewhat younger and smoked more frequently than respondents; however, there were no differences in patient-reported outcome measures. Our findings suggest that attrition bias in NORspine was random and due to non-modifiable factors.

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Differences in Baseline Characteristics and Outcome Among Responders, Late Responders, and Never-Responders After Anterior Cruciate Ligament Reconstruction

Cited by 6 publications

References 28 publications

Characteristics and outcomes of patients who did not respond to a national spine surgery registry.

Characteristics and outcomes of patients who did not respond to a national spine surgery registry.

Patient-Reported Outcome, Return to Sport, and Revision Rates 7-9 Years After Anterior Cruciate Ligament Reconstruction: Results From a Cohort of 2042 Patients

Characteristics and outcomes of patients who did not respond to a national spine surgery registry

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