Preoperative Patient and Injury Factors of Successful Rehabilitation After Anterior Cruciate Ligament Reconstruction With Single-Bundle Techniques

Faculty of Medicine, Health and Life Sciences, Maastricht University, Maastricht, The Netherlands. Electronic address: .
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.21). 11/2013; 29(11):1879-95. DOI: 10.1016/j.arthro.2013.07.273
Source: PubMed


The aim of this systematic review was to determine which patient determinants and injury factors, before anterior cruciate ligament reconstruction by arthroscopic single-bundle techniques, affect postoperative rehabilitation.
A search of PubMed, Embase, and the Cochrane Database of Clinical Trials was performed up to February 2013. After application of our inclusion criteria, a final selection was made based on studies' methodologic score assessed with the Newcastle-Ottawa Scale. Meta-analysis was planned for each prognostic factor when data were considered clinically and statistically homogeneous.
Meta-analysis showed that male patients have better functional outcomes. Qualitative synthesis from 18 high-quality studies showed that patients operated on before 30 years of age reach higher activity levels. Patients with high baseline body mass index have lower activity levels after surgery. Smoking results in more symptoms and lower activity levels and subjective scores. Reconstruction before 3 months results in higher activity levels. Preoperatively, a less than 20% quadriceps strength difference, 50° of tibial external rotation or less, absence of flexion deficits, low knee influence on the patient's activity level, and less anterior knee pain result in higher functional scores. Preoperative anterior laxity difference does not predict functional scores. The prognostic value of preoperative activity and competition level for postoperative functional outcome is controversial. Patients with concomitant meniscal injuries have worse functional outcomes. The prognostic value of concomitant chondral pathology for postoperative functional outcome is controversial. Collateral ligament injury could predict functional scores or activity level.
Male gender, patient age younger than 30 years, reconstruction before 3 months, and high baseline activity level contribute to better functional outcomes. Smoking, high body mass index, quadriceps strength, and range-of-motion deficits affect rehabilitation negatively. Preoperative anterior laxity does not influence rehabilitation. The role of preoperative prognostic injury factors remains unclear because of limited evidence.
Level III, systematic review of Level II and III studies.

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Available from: Eric W P Bakker, Dec 12, 2014
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    • "We chose to study the results six months after ACL reconstruction, because most athletes are allowed to return to sport around six months after injury [34]. Moreover, Valk et al. showed that only few studies examined prognostic factors in this time frame [4]. Before the start of the study, the local medical ethical commission (Verenigde Commissies Mensgebonden Onderzoek (VCMO), Nieuwegein, the Netherlands) approved the study (registration number W14 "
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    ABSTRACT: In the past, several studies investigated factors that are prognostic or associated with outcome after anterior cruciate ligament (ACL) reconstruction. A recent review showed that only limited evidence is available for most studied factors, and that insufficient analysis methods were used commonly. Therefore, the aim of this study was to add more weight to the existing evidence, about factors that are associated with a more rapid outcome after ACL reconstruction. The second aim was to use multivariate analysis to study the possible factors independently. A cohort study was conducted with a follow-up of six months. Before surgery, patient variables were scored. Surgical variables were scored during arthroscopic ACL reconstructions with a single-bundle technique and hamstring autograft. The Lysholm score and subscales of the Knee Injury Osteoarthritis Outcome Score (KOOS) were assessed six months post surgery. A multiple analysis of variance (ANOVA) model was used to identify prognostic factors for outcome. In total, 118 patients were included. Patients, aged ≤30years, with a subjective knee score ≥ six, with normal flexion range of motion (ROM) of the knee, with flexion and extension strength deficit of ≤20%, and those with no previous knee surgery in the same knee at baseline scored significantly higher on outcome after multivariate analysis. No significant effect of surgical factors could be found. Younger age, higher subjective knee score, normal knee flexion, normal knee flexion and extension strength, and no previous knee surgery in the patients' history at baseline are associated with a more rapid recovery after ACL reconstruction. Level III, prognostic study. Copyright © 2015 Elsevier B.V. All rights reserved.
    Full-text · Article · Aug 2015 · The Knee

  • No preview · Article · Nov 2013 · Arthroscopy The Journal of Arthroscopic and Related Surgery
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    ABSTRACT: Background Preoperative knee function is associated with successful postoperative outcome after anterior cruciate ligament reconstruction (ACLR). However, there are few longer term studies of patients who underwent progressive preoperative and postoperative rehabilitation compared to usual care. Objectives To compare preoperative and 2 year postoperative patient-reported outcomes (PROs) in patients undergoing progressive preoperative and postoperative rehabilitation at a sports medicine clinic compared with usual care. Methods We included patients aged 16–40 years undergoing primary unilateral ACLR. The preoperative and 2 year postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) of 84 patients undergoing progressive preoperative and postoperative rehabilitation at a sports medicine clinic (Norwegian Research Center for Active Rehabilitation (NAR) cohort) were compared with the scores of 2690 patients from the Norwegian National Knee Ligament Registry (NKLR). The analyses were adjusted for sex, age, months from injury to surgery and cartilage/meniscus injury at ACLR. Results The NAR cohort had significantly better preoperative KOOS in all subscales, with clinically relevant differences (>10 points) observed in KOOS Pain, activities of daily living (ADL), Sports and Quality of Life. At 2 years, the NAR cohort still had significantly better KOOS with clinically relevant differences in KOOS Symptoms, Sports and Quality of Life. At 2 years, 85.7–94% of the patients in the NAR cohort scored within the normative range of the different KOOS subscales, compared to 51.4–75.8% of the patients in the NKLR. Conclusions Patients in a prospective cohort who underwent progressive preoperative and postoperative rehabilitation at a sports medicine clinic showed superior patient-reported outcomes both preoperatively and 2 years postoperatively compared to patients in the NKLR who received usual care.
    Full-text · Article · Oct 2014 · British Journal of Sports Medicine
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