Abstract
Purpose
The literature indicates a lack of consensus on the correlation between knee laxity after anterior cruciate ligament reconstruction (ACLR) and subjective clinical outcomes and the need for revision surgery. Therefore, using high-volume registry data, this study aimed to describe the relationship between objective knee laxity after ACLR and subjective symptom and functional assessments and the need for revision surgery. The hypothesis was that greater postoperative knee laxity would correlate with inferior patient-reported outcomes and a higher risk for revision surgery.
Methods
In this study, 17,114 patients in the Danish knee ligament reconstruction registry were placed into three groups on the basis of objective side-to-side differences in sagittal laxity one year after surgery: group A (≤ 2 mm), Group B (3–5 mm) and Group C (> 5 mm). The main outcome measure was revision rate within 2 years of primary surgery, further outcome measures were the knee injury and osteoarthritis outcome score (KOOS) as well as Tegner activity score.
Results
The study found the risk for revision surgery was more than five times higher for Group C [hazard ratio (HR) = 5.51] than for Group A. The KOOS knee-related Quality of Life (QoL) sub-score exhibited lower values when comparing Groups B or C to Group A. In addition, the KOOS Function in Sport and Recreation (Sport/Rec) sub-score yielded lower values for groups B and C in comparison with Group A.
Conclusion
These results indicate that increased post-operative sagittal laxity is correlated with an increased risk for revision surgery and might correlate with poorer knee-related QoL, as well as a decreased function in sports. The clinical relevance of the present study is that high knee laxity at 1-year follow-up is a predictor of the risk of revision surgery.
Level of evidence
III.
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Abbreviations
- ACL:
-
Anterior cruciate ligament
- DKRR:
-
The Danish knee ligament reconstruction registry
- SSD:
-
Side-to-side difference
- KOOS:
-
The knee injury and osteoarthritis outcome score
- QoL:
-
Quality of life
- Sport/Rec:
-
Sport and recreation
- ACLR:
-
Anterior cruciate ligament reconstruction
- PROMs:
-
Patient-reported outcome measures
- IKDC:
-
International knee documentation committee
- ADL:
-
Function in daily living
- ST:
-
Hamstring tendon
- PT:
-
Patella tendon
- QT:
-
Quadriceps tendon
- n.s.:
-
Non-significant
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MF: Writing of manuscript, data-analysis, literature search. ML: Study design, data interpretation, manuscript revision. TGN: Data-analysis, data interpretation, manuscript revision.
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No written consent is necessary in Denmark for studies based on data from the National Board of Health-approved national healthcare registries. However, the study was approved by the Regional Centre for Clinical Quality Development and the National Data Protection Agency.
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Fiil, M., Nielsen, T.G. & Lind, M. A high level of knee laxity after anterior cruciate ligament reconstruction results in high revision rates. Knee Surg Sports Traumatol Arthrosc 30, 3414–3421 (2022). https://doi.org/10.1007/s00167-022-06940-5
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DOI: https://doi.org/10.1007/s00167-022-06940-5