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Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes

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Knee Arthroscopy and Knee Preservation Surgery

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Abstract

Anterior cruciate ligament reconstruction (ACLR) is one of the most commonly performed procedures in the world. As such, functional and clinical outcomes following ACLR are a very well-studied topic in the orthopedic literature. The most widely used measures to assess ACLR outcomes are validated patient reported outcome measurements (PROMs) such as the Lysholm, International Knee Documentation Committee (IKDC), Tegner, and Knee injury and Osteoarthritis Outcome Scores (KOOS). Despite their subjective nature, they do provide valuable insight into the functional outcomes of ACLR. Other important clinical outcomes following ACLR are return to sport (RTS), graft failure (or rerupture), and postoperative complications.

As PROMs are based on patient perception, they are inherently subjective. Other outcome measurements of ACL laxity such as the anterior drawer, Lachman, and pivot-shift – which have their own standardized grading schemes – may offer more objectivity in a clinical setting. However, they may only display moderate levels of interrater reliability. More truly objective methods of ACL laxity measurement are available such as the KT-1000 arthrometer, but they are not widely used in a clinical setting.

The focus of this chapter will be to describe factors that influence clinical and functional outcomes after primary ACL reconstruction. To do so, several patient and surgical factors have been selected and categorized into three perioperative time points – preoperative, intraoperative, and postoperative factors.

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Abbreviations

MCID:

Minimal clinically important difference; the minimal important change that represents the smallest meaningful change in a patient’s condition

IKDC:

International Knee Documentation Committee

KOOS:

Knee injury and Osteoarthritis Outcome Scores

BPTB:

Bone-patellar tendon-bone graft

HT:

Hamstring tendon graft

QT:

Quadriceps tendon graft

ALLR:

Anterolateral ligament reconstruction

LET:

Lateral extra-articular tenodesis

STABILITY trial:

Standard ACL Reconstruction vs ACL + Lateral Extra-Articular Tenodesis Study (STAbiLiTY); an RCT of 618 patients with a mean age of 18.9 years (range, 14-25 years) completed in 2019

STABILITY 2 trial:

Anterior Cruciate Ligament Reconstruction +/− Lateral Tenodesis With Patellar vs Quad Tendon (STABILITY 2); an ongoing RCT

SQuASH trial:

Soft-tissue Quadriceps Autograft ACL-reconstruction in the Skeletally-immature vs. Hamstrings; an ongoing RCT

KT-1000 arthrometry:

A device that was developed to measure anterior and posterior translation of the tibia relative to the femur

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, ON, Canada

    David Slawaska-Eng & Darren de SA

  2. Department of Medicine, McMaster University, Hamilton, ON, Canada

    Caitlin Yee & Colin Kruse

  3. Mercy Health – Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, OH, USA

    Mahmoud Almasri

Authors
  1. David Slawaska-Eng
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  2. Caitlin Yee
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  3. Colin Kruse
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  4. Mahmoud Almasri
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  5. Darren de SA
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Corresponding author

Correspondence to Darren de SA .

Editor information

Editors and Affiliations

  1. Sports Medicine Clinic, Stanford University, Redwood City, CA, USA

    Seth L. Sherman

  2. Midwest Orthopedics, Rush University, Chicago, IL, USA

    Jorge Chahla

  3. Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA

    Scott A. Rodeo

  4. Complex Knee and Sports Medicine Surgeon, Twin Cities Spine Center, Edina, MN, USA

    Robert LaPrade

Section Editor information

  1. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA

    Volker Musahl

  2. Division of Sports Medicine, Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Volker Musahl

  3. Jordan-Young Institute, Virginia Beach, United States

    Kevin Bonner

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Slawaska-Eng, D., Yee, C., Kruse, C., Almasri, M., de SA, D. (2023). Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes. In: Sherman, S.L., Chahla, J., Rodeo, S.A., LaPrade, R. (eds) Knee Arthroscopy and Knee Preservation Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-82869-1_35-1

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  • DOI: https://doi.org/10.1007/978-3-030-82869-1_35-1

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