Factors Affecting the Achievement of a Patient-Acceptable Symptom State 1 Year After Anterior Cruciate Ligament Reconstruction: A Cohort Study of 343 Patients From 2 Registries

Abstract

Background:There is insufficient knowledge regarding the influence of concomitant injuries on the recovery of short-term subjective knee function after anterior cruciate ligament (ACL) reconstruction.Purpose:To determine whether patient characteristics, concomitant injuries, and graft choice during ACL reconstruction can predict which patients achieve acceptable knee function 1 year after reconstruction.Study Design:Case-control study; Level of evidence, 3.Methods:Data from 1 physical therapist–specific and 1 surgeon-specific register were used. Patients who had completed the Knee injury and Osteoarthritis Outcome Score (KOOS) at 1-year follow-up were included. Additional intraoperative information was extracted from a database. The primary outcome was achieving a patient-acceptable symptom state (PASS) for each subscale of the KOOS. Univariable and multivariable logistic regression models were used, with patient sex, age, and preinjury level of physical activity as covariates.Results:A total of 343 patients (51% females) were included. The proportion of patients achieving PASS 1 year after ACL reconstruction varied between 40% and 85% among the KOOS subscales. Younger age at reconstruction and male sex provided favorable odds of achieving acceptable knee function across the KOOS subscales. Patients without cartilage injury had increased odds of achieving PASS in the KOOS sport and recreation subscale; the increase was 1.63-fold (95% CI, 1.01-2.64; P = .045). Patients receiving patellar tendon autograft had a 0.41-fold (95% CI, 0.19-0.85; P = .017) decrease in odds of achieving PASS on the KOOS quality of life (QoL) subscale. In the multivariable analysis, increased odds of achieving PASS on the KOOS QoL subscale were associated with the absence of meniscal injury (odds ratio, 1.62; 95% CI, 1.04-2.54; P = .035), and increased odds were found for hamstring tendon autograft (OR, 2.63; 95% CI, 1.25-5.56; P = .011).Conclusion:More than half of the patients reported an acceptable symptom state on 4 of the 5 KOOS subscales 1 year after ACL reconstruction. A lack of consistency was noted related to the effect of concomitant knee injuries and graft choice on acceptable knee function. However, younger age and male sex were favorable, nonmodifiable characteristics that increased the odds of early acceptable function.

Prospective Evaluation of the Patient Acceptable Symptom State to Identify Clinically Successful Anterior Cruciate Ligament Reconstruction

“…Interestingly, a recent study by Hamrin Senorski et al 6 reported PASS-Y rates of 56.9% and 50.4% for KOOS Pain and KOOS QOL , respectively, in a similar ACLR population at 1-year follow-up. Although obvious explanations for these discrepancies are not readily apparent, it is worth nothing that Hamrin Senorski et al 6 determined postoperative PASS status exclusively by comparing KOOS scores with the PASS thresholds described by Muller et al 20 Thus, it is quite possible that the PASS-Y rate is artificially low, as some patients likely achieved PASS despite their postoperative KOOS scores’ falling below the PASS threshold. Additionally, baseline KOOS scores were not collected, which prohibited the authors from assessing the change in KOOS scores over time.…”

Clinical Outcomes After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group

“… 75 Several studies have since then applied the PASS values for the KOOS and IKDC-SKF when reporting on outcome after ACL treatment. 26 , 42 , 44 , 111 …”

Clinical outcomes after anterior cruciate ligament injury: panther symposium ACL injury clinical outcomes consensus group

“…Thresholds for the PASS have been established for the KOOS and the IKDC-SKF by asking the question: “Taking account of all the activity you have during your daily life, your level of pain and also your activity limitations and participations restrictions, do you consider the current state of your knee satisfactory?” alongside the administered PRO [ 76 ]. Several studies have since then applied the PASS values for the KOOS and IKDC-SKF when reporting on outcome after ACL treatment [ 27 , 43 , 45 , 117 ].…”