Which Preoperative Factors, Including Bone Bruise, Are Associated With Knee Pain/Symptoms at Index Anterior Cruciate Ligament Reconstruction (ACLR)? A Multicenter Orthopaedic Outcomes Network (MOON) ACLR Cohort Study

Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical School, Nashville, TN 37232-8300, USA.
The American Journal of Sports Medicine (Impact Factor: 4.36). 09/2010; 38(9):1778-87. DOI: 10.1177/0363546510370279
Source: PubMed


Increased knee pain at the time of anterior cruciate ligament reconstruction may potentially predict more difficult rehabilitation, prolonged recovery, and/or be predictive of increased knee pain at 2 years.
A bone bruise and/or other preoperative factors are associated with more knee pain/symptoms at the time of index anterior cruciate ligament reconstruction, and the presence of a bone bruise would be associated with specific demographic and injury-related factors.
Cohort study (prevalence); Level of evidence, 2.
In 2007, the Multicenter Orthopaedic Outcomes Network (MOON) database began to prospectively collect surgeon-reported magnetic resonance imaging bone bruise status. A multivariable analysis was performed to (1) determine if a bone bruise, among other preoperative factors, is associated with more knee symptoms/pain and (2) examine the association of factors related to bone bruise. To evaluate the association of a bone bruise with knee pain/symptoms, linear multiple regression models were fit using the continuous scores of the Knee injury and Osteoarthritis Outcome Score (KOOS) symptoms and pain subscales and the Short Form 36 (SF-36) bodily pain subscale as dependent variables. To examine the association between a bone bruise and risk factors, a logistic regression model was used, in which the dependent variable was the presence or absence of a bone bruise.
Baseline data for 525 patients were used for analysis, and a bone bruise was present in 419 (80%). The cohort comprises 58% male patients, with a median age of 23 years. The median Marx activity level was 13. Factors associated with more pain were higher body mass index (P < .0001), female sex (P = .001), lateral collateral ligament injury (P = .012), and older age (P = .038). Factors associated with more symptoms were a concomitant lateral collateral ligament injury (P = .014), higher body mass index (P < .0001), and female sex (P < .0001). Bone bruise is not associated with symptoms/pain at the time of index anterior cruciate ligament reconstruction. None of the factors included in the SF-36 bodily pain model were found to be significant. After controlling for other baseline factors, the following factors were associated with a bone bruise: younger age (P = .034) and not jumping at the time of injury (P = .006).
After anterior cruciate ligament injury, risk factors associated with a bone bruise are younger age and not jumping at the time of injury. Bone bruise is not associated with symptoms/pain at the time of index anterior cruciate ligament reconstruction.

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Available from: Kurt P Spindler, Sep 10, 2015
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    • "With regard to the correlation of OPN levels and articular cartilage damage, we found that OPN Full levels are positively correlated with the severity of articular cartilage damage in lateral tibial plateau (Fig. 2). Lateral tibial plateau is the region where bone bruise is most frequently observed by X-ray and MRI (magnetic resonance imaging) after ACL injury [38]. This suggests that OPN Full may accelerate inflammation-induced cartilage degradation. "
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    ABSTRACT: Introduction The sports medicine community has only recently begun to develop and use registries and other large prospective cohorts to evaluate outcomes following anterior cruciate ligament (ACL) reconstruction. There is no study describing the epidemiology of ACL reconstructions in a non-Western society. It is hypothesized that significant differences will be noted between the Brunei patient population and those reported in large Western registries. Materials and methods Demographic data and surgical findings for all patients undergoing ACL reconstruction between January 1, 2008 and December 31, 2010 were collected retrospectively. The resulting data were compared with baseline data from the Scandinavian registries and the Multicenter Orthopaedic Outcome Network (MOON) cohort in the USA. Results A total of 214 ACL reconstructions were performed during the study period. The age of patients undergoing surgery as well as the delay from injury to surgery was relatively similar in Brunei and Scandinavia. The patients in the MOON cohort were generally younger and underwent surgery sooner. The most common activity causing injury was football. All patients in Brunei underwent ACL reconstruction with hamstring autografts. Conclusions Registries provide detailed epidemiological data that can be used to calculate revision rates, assess patient-reported outcome scores, and compare various techniques and implants. Inclusion of cases from an entire country minimizes selection bias and maximizes data volume. This registry will, in the future, be improved by initiating the collection of pre- and post-operative patient-reported outcome scores and improving documentation strategies for cartilage defects. The national registry will generate new data about ACL reconstructions and contribute to better understanding of ACL epidemiology.
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