Predictors of Patient-Reported Outcomes at 2 Years After Revision Anterior Cruciate Ligament Reconstruction
The MARS Group. Am J Sports Med. 2019; 47 (10): 2394-2401. DOI:10.1177/0362546519862279
Take Home Message
A person with better patient-reported outcomes scores at the time of a revision anterior cruciate ligament reconstruction or more time between surgeries is more likely to have better patient-reported outcomes 2 years after a revision surgery.
Patients who undergo an anterior cruciate ligament (ACL) reconstruction revision surgery often have poorer outcomes than patients who never need a revision after their primary ACL reconstruction. However, it is unclear if certain factors at the time of a revision surgery may help clinicians identify patients at risk for poor outcomes. The multicenter ACL Revision Study (MARS) consortium conducted a prospective cohort study to study if factors at the time of surgery (e.g., patient-reported outcomes [PROs], demographics, surgical techniques, concomitant injuries) related to outcomes 2 years after a revision surgery. Eighty two percent of the enrolled participants (989 participants) completed the 2-year follow-up. Overall, participants improved in almost every PRO over 2 years, except for knee stiffness and physical activity levels, which decreased. Someone with better PROs at the time of surgery and longer time between ACL surgeries was more likely to have better self-reported knee-related symptoms and function at 2 years after a revision surgery (based on KOOS, WOMAC, or IKDC). Conversely, someone with a previous lateral meniscectomy or a patellofemoral cartilage defect was more likely to have a poor outcome at 2 years after revision.
This study is very interesting because it clearly shows that baseline PROs relate to how a patient may feel 2 years after their revision surgery. This provides tremendous support for clinicians to use PROs within their patient care to help guide patient expectations. It would have been interesting to see what these patients’ PROs were in the months leading up to the ACL revision surgery, and what trajectory they followed. Furthermore, it would be interesting to see how the patients perceived their current symptom state and if they thought the revision surgery was a success. Despite these new findings, it is difficult to determine why people with an ACL revision have poorer outcomes than their peers. The authors do a great job comparing their findings to previous work by other research groups, but it would be interesting to continue to follow these patients out beyond 2 years to see if they continue to improve, or if they plateau at any point. Ultimately, clinicians should use PROs with patients who plan to undergo a revision surgery to help educate patients about what they may expect after surgery.
Questions for Discussion
What PROs are you using clinically? What barrier do you see for implementing the regular use of PROs with your patients?
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban
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