Preoperative knee laxity measurements predict the achievement of a patient-acceptable symptom state after ACL reconstruction: a prospective multicenter study

• Objective To determine whether patient-related factors, concomitant injuries and preoperative knee laxity could predict a patient acceptable symptom state (PASS) in the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) at 1 and 2 years follow-up after anterior cruciate ligament (ACL) reconstruction in a multicentre cohort. Methods Patients between 14 and 50 years of age who underwent single-bundle ACL reconstruction with hamstring tendon autograft within 1 year from the index injury were eligible. Additionally, only patients who completed the IKDC-SKF questionnaire at 1 or 2 years of follow-ups were included. Preoperative knee laxity assessment of patients in the awake state was performed using rolimeter, the Lachman and the pivot-shift test. The pivot shift was graded according to the IKDC criteria and also quantified by the use of non-invasive technology for (1) lateral tibial translation and (2) tibial acceleration. The quantitative pivot shift (QPS) was examined in the awake state and under anaesthesia (EUA). Univariable logistic regression models were performed with achieving PASS in the IKDC as the dependent variable. Results A total of 86 patients had complete data on the IKDC-SKF score at 1-year follow-up, of which 67 patients (77.9%) achieved PASS (age 24.8±9.3 years, 43% females). Two-year data were available for 50 patients, of which 39 patients (78.9%) achieved PASS (age 23.9±9.2 years, 42.0% females). A low-grade manual pivot shift according to IKDC grading had increased odds of achieving PASS at 1 year (OR=2.96 (95% CI 1.01 to 8.66), P<0.05) compared with patients who displayed a high-grade pivot shift preoperatively. However, this was not confirmed by the preoperative QPS measures (awake: tibial translation; OR=0.99,(95% CI 0.72 to 1.35), (n.s.), acceleration; OR=1.04,(95% CI 0.68 to 1.59), (n.s.) EUA: tibial translation; OR=1.02 (95% CI 0.78 to 1.31), (n.s.), acceleration; OR=1.14 (95% CI 0.93 to 1.40), (n.s.)). None of the studied variables of patient characteristics, concomitant injuries or knee joint laxity predicted PASS at the 2-year follow-up. Conclusion Almost four in every five patients were able to achieve PASS 1 and 2 years after anatomic single-bundle ACL reconstruction. The presence of preoperative low-grade pivot shift increased the odds of achieving an acceptable level of knee function 1 year after ACL reconstruction compared with high-grade pivot shift; however, QPS did not confirm achievement of PASS in this study. Level of evidence Level III, prospective cohort.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Ortopedi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Orthopaedics (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)

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