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A high level of knee laxity after anterior cruciate ligament reconstruction results in high revision rates

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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Fig. 1

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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Authors and Affiliations

Authors

Contributions

MF: Writing of manuscript, data-analysis, literature search. ML: Study design, data interpretation, manuscript revision. TGN: Data-analysis, data interpretation, manuscript revision.

Corresponding author

Correspondence to Martin Lind.

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Conflict of interest

None.

Ethical approval

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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Not needed.

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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

Keywords

  • ACL reconstruction
  • Patient-reported outcome
  • Objective knee laxity
  • Revision rate
  • ACL registry