Patients Follow 3 Different Rate-of-Recovery Patterns After Anterior Cruciate Ligament Reconstruction Based on International Knee Documentation Committee Score.

Abstract

PURPOSE:

To determine whether subgroups of patients exist based on the rate-of-recovery pattern of International Knee Documentation Committee (IKDC) scores after anterior cruciate ligament reconstruction (ACLR) and to determine clinical predictors for these subgroups.

METHODS:

Patients who underwent primary or revision ACLR at a single institution from January 2014 to January 2019 were identified. Latent class growth analyses and growth mixture models (GMMs) with 1 to 6 classes were used to identify subgroups of patients based on functional rate-of-recovery patterns by use of preoperative, 1-year postoperative, and 2-year postoperative IKDC scores.

RESULTS:

A total of 245 patients who underwent ACLR were included in the analysis. A 3-class GMM was chosen as the final model after 6 different models were run. Class 1, showing improvement from preoperatively to 1-year follow-up, with sustained improvement from 1 to 2 years postoperatively, constituted 77.1% of the study population (n = 189), whereas class 2, showing functional improvement between 1- and 2-year follow-up, was the smallest class, constituting 10.2% of the study population (n = 25), and class 3, showing slight improvement at 1-year follow-up, with a subsequent decline in IKDC scores between 1- and 2-year follow-up, constituted 12.7% of the study population (n = 31). Revision surgery (P = .005), a psychiatric history (P = .025), preoperative chronic knee pain (P = .024), and a subsequent knee injury within the follow-up period (P = .011) were the predictors of class 2 and class 3 rate-of-recovery patterns. Patient demographic characteristics, graft type, and concomitant ligament, meniscus, or cartilage injury at the time of surgery were not associated with the different recovery patterns described in this study.

CONCLUSIONS:

Patients may follow different rate-of-recovery patterns after ACLR. By use of the GMMs, 3 different rate-of-recovery patterns based on IKDC scores were identified. Although most patients follow a more ideal rate-of-recovery pattern, fewer patients may follow less favorable patterns. Revision surgery, a history of psychiatric illness, preoperative chronic knee pain, and a subsequent knee injury within the follow-up period were predictive of less favorable rate-of-recovery patterns.

LEVEL OF EVIDENCE:

Level III, retrospective cohort study.

• Authors: Safa Gursoy, Ian M Clapp, Allison K Perry, Alex Hodakowski, Benjamin Kerzner, Harsh Singh, Amar S Vadhera, Bernard R Bach Jr, Charles A Bush-Joseph, Brian Forsythe, Adam B Yanke, Nikhil N Verma, Brian J Cole, Jorge Chahla
• Journal: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association (Arthroscopy) Vol. 38 Issue 8 Pg. 2480-2490.e3 (08 2022) ISSN: 1526-3231 [Electronic] United States
• PMID: 35337956 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Topics

• Anterior Cruciate Ligament (surgery)
• Anterior Cruciate Ligament Injuries (surgery)
• Anterior Cruciate Ligament Reconstruction
• Documentation
• Humans
• Knee Injuries (surgery)
• Knee Joint (surgery)
• Pain (surgery)
• Retrospective Studies
• Treatment Outcome