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Effect of High-Grade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes.
Am J Sports Med 2016; 44(12):3077-3082AJ

Abstract

BACKGROUND

Knee laxity in the setting of suspected anterior cruciate ligament (ACL) injury is frequently assessed through physical examination using the Lachman, pivot-shift, and anterior drawer tests. The degree of laxity noted on these examinations may influence treatment decisions and prognosis.

HYPOTHESIS

Increased preoperative knee laxity would be associated with increased risk of subsequent revision ACL reconstruction and worse patient-reported outcomes 2 years postoperatively.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

From an ongoing prospective cohort study, 2333 patients who underwent primary isolated ACL reconstruction without collateral or posterior cruciate ligament injury were identified. Patients reported by the operating surgeons as having an International Knee Documentation Committee (IKDC) grade D for Lachman, anterior drawer, or pivot-shift examination were classified as having high-grade laxity. Multiple logistic regression modeling was used to evaluate whether having high-grade preoperative laxity was associated with increased odds of undergoing revision ACL reconstruction within 2 years of the index procedure, controlling for patient age, sex, Marx activity level, level of competition, and graft type. Multiple linear regression modeling was used to evaluate whether having high-grade preoperative laxity was associated with worse IKDC score or Knee injury and Osteoarthritis Outcome Score Knee-Related Quality of Life subscale (KOOS-QOL) scores at a minimum 2 years postoperatively, controlling for baseline score, patient age, ethnicity, sex, body mass index, marital status, smoking status, sport participation, competition level, Marx activity rating score, graft type, and articular cartilage and meniscus status.

RESULTS

Pre-reconstruction laxity data were available for 2325 patients (99.7%). Two-year revision data were available for 2259 patients (96.8%), and patient-reported outcomes were available for 1979 patients (84.8%). High-grade preoperative laxity was noted in 743 patients (31.9%). The mean postoperative IKDC score was 81.8 ± 15.9, and the mean KOOS-QOL score was 72.0 ± 22.0. The presence of high-grade pre-reconstruction laxity was associated with significantly increased odds of ACL graft revision (odds ratio [OR] = 1.87 [95% CI, 1.19-2.95]; P = .007). The presence of high-grade pre-reconstruction laxity was not associated with any difference in postoperative IKDC (β = -0.56, P = .44) or KOOS-QOL (β = 0.04, P = .97).

CONCLUSION

The presence of high-grade pre-reconstruction knee laxity as assessed by manual physical examination under anesthesia is associated with significantly increased odds of revision ACL surgery but has no association with patient-reported outcome scores at 2 years after ACL reconstruction.

Authors+Show Affiliations

Department of Orthopaedics, The Ohio State University, Columbus, OH, USA robert.magnussen@gmail.com. OSU Sports Medicine, Sports Health and Performance Institute, The Ohio State University, Columbus, OH, USA.Department of Orthopaedics and Rehabilitation, Vanderbilt University, Nashville, TN, USA.Department of Orthopaedics and Rehabilitation, Vanderbilt University, Nashville, TN, USA.No affiliation info availableDepartment of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Sports Medicine Center, Mayo Clinic, Minneapolis and Rochester, MN, USA.Department of Orthopaedics, Cleveland Clinic Foundation, Cleveland, OH, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27480978

Citation

Magnussen, Robert A., et al. "Effect of High-Grade Preoperative Knee Laxity On Anterior Cruciate Ligament Reconstruction Outcomes." The American Journal of Sports Medicine, vol. 44, no. 12, 2016, pp. 3077-3082.
Magnussen RA, Reinke EK, Huston LJ, et al. Effect of High-Grade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes. Am J Sports Med. 2016;44(12):3077-3082.
Magnussen, R. A., Reinke, E. K., Huston, L. J., Hewett, T. E., & Spindler, K. P. (2016). Effect of High-Grade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes. The American Journal of Sports Medicine, 44(12), pp. 3077-3082.
Magnussen RA, et al. Effect of High-Grade Preoperative Knee Laxity On Anterior Cruciate Ligament Reconstruction Outcomes. Am J Sports Med. 2016;44(12):3077-3082. PubMed PMID: 27480978.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of High-Grade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes. AU - Magnussen,Robert A, AU - Reinke,Emily K, AU - Huston,Laura J, AU - ,, AU - Hewett,Timothy E, AU - Spindler,Kurt P, Y1 - 2016/08/01/ PY - 2016/8/3/pubmed PY - 2017/10/24/medline PY - 2016/8/3/entrez KW - anterior cruciate ligament KW - diagnosis KW - knee laxity KW - knee ligaments SP - 3077 EP - 3082 JF - The American journal of sports medicine JO - Am J Sports Med VL - 44 IS - 12 N2 - BACKGROUND: Knee laxity in the setting of suspected anterior cruciate ligament (ACL) injury is frequently assessed through physical examination using the Lachman, pivot-shift, and anterior drawer tests. The degree of laxity noted on these examinations may influence treatment decisions and prognosis. HYPOTHESIS: Increased preoperative knee laxity would be associated with increased risk of subsequent revision ACL reconstruction and worse patient-reported outcomes 2 years postoperatively. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: From an ongoing prospective cohort study, 2333 patients who underwent primary isolated ACL reconstruction without collateral or posterior cruciate ligament injury were identified. Patients reported by the operating surgeons as having an International Knee Documentation Committee (IKDC) grade D for Lachman, anterior drawer, or pivot-shift examination were classified as having high-grade laxity. Multiple logistic regression modeling was used to evaluate whether having high-grade preoperative laxity was associated with increased odds of undergoing revision ACL reconstruction within 2 years of the index procedure, controlling for patient age, sex, Marx activity level, level of competition, and graft type. Multiple linear regression modeling was used to evaluate whether having high-grade preoperative laxity was associated with worse IKDC score or Knee injury and Osteoarthritis Outcome Score Knee-Related Quality of Life subscale (KOOS-QOL) scores at a minimum 2 years postoperatively, controlling for baseline score, patient age, ethnicity, sex, body mass index, marital status, smoking status, sport participation, competition level, Marx activity rating score, graft type, and articular cartilage and meniscus status. RESULTS: Pre-reconstruction laxity data were available for 2325 patients (99.7%). Two-year revision data were available for 2259 patients (96.8%), and patient-reported outcomes were available for 1979 patients (84.8%). High-grade preoperative laxity was noted in 743 patients (31.9%). The mean postoperative IKDC score was 81.8 ± 15.9, and the mean KOOS-QOL score was 72.0 ± 22.0. The presence of high-grade pre-reconstruction laxity was associated with significantly increased odds of ACL graft revision (odds ratio [OR] = 1.87 [95% CI, 1.19-2.95]; P = .007). The presence of high-grade pre-reconstruction laxity was not associated with any difference in postoperative IKDC (β = -0.56, P = .44) or KOOS-QOL (β = 0.04, P = .97). CONCLUSION: The presence of high-grade pre-reconstruction knee laxity as assessed by manual physical examination under anesthesia is associated with significantly increased odds of revision ACL surgery but has no association with patient-reported outcome scores at 2 years after ACL reconstruction. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/27480978/Effect_of_High_Grade_Preoperative_Knee_Laxity_on_Anterior_Cruciate_Ligament_Reconstruction_Outcomes_ L2 - http://journals.sagepub.com/doi/full/10.1177/0363546516656835?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -