Pre-operative factors influence on ACL reconstruction surgery on patient reported outcomes - Do concomitant injuries matter?

Abstract

Introduction and Objective The anterior cruciate ligament (ACL) is the central stabilizer of the knee joint and is more vulnerable to injury, as a result of impact or while playing sports. Once torn, it cannot repair itself. Due to its possible long-term consequences, this injury has a significant impact on patient's lives. The first line of treatment is frequently surgical reconstruction, along with muscle and motion rehabilitation. The used technique, concomitant knee injuries, postoperative complications and postoperative rehabilitation are conditioners in patients' recovery and should be taken into consideration, since symptoms such as swelling, pain and instability may persist. This study aims to assess the impact of concomitant injuries on patients related surgical outcome. Methods In this cohort retrospective study, patients that underwent ACL reconstruction from 2006 to 2019 at a level 3 hospital were contacted. Exclusion criteria were politrauma and nonreachable patients. Data was gathered using the Knee Injury and Osteoarthritis Outcome Score (KOOS), using the Modified Cincinatti Score and Tegner Lysholm Score questionnaires to calculate each score, respectively. Statistical analysis was performed using IBM SPSS statistics, version 27. Results Of the 416 patients eligible to this study, 184 answered the questionnaire. 82,6% of the patients were male and 21,2% were injured while playing sports. Median waiting time for surgery was 11 months (8-19) and the median age for surgery was 29 years (22-38). Median value of scores was 95,80 (91,70-98,80) at KOOS, 95,00 (88,00-100,00) at Modified Cincinnati and 95,00 (86,00-100,00) at Tegner Lysholm. Statistical significance (p<0,05) was only found concerning presence of reinjury. Conclusion The impact of meniscus procedures, meniscus tears and chondral lesions on patients that undergo ACL repair surgery remain controversial. The only statistically significant association was reinjury of ACL tear, which highlights its impact on post-surgical outcomes and and the role its prevention might play in the patient's recovery. The absence of statistically significant associations is consistent with the controversial results obtained in the literature, which highlights the need for more broader studies using preoperatively and postoperatively alternative scoring systems such as clinician-completed and patient-completed to evaluate intra articular concomitant pathology in ACL deficient knees.