Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA.
Am J Sports Med. 2022 Jun;50(7):1788-1797. doi: 10.1177/03635465221094621.
Patients with anterior cruciate ligament (ACL) revision report lower outcome scores on validated knee questionnaires postoperatively compared to cohorts with primary ACL reconstruction. In a previously active population, it is unclear if patient-reported outcomes (PROs) are associated with a return to activity (RTA) or vary by sports participation level (higher level vs. recreational athletes).
Individual RTA would be associated with improved outcomes (ie, decreased knee symptoms, pain, function) as measured using validated PROs. Recreational participants would report lower PROs compared with higher level athletes and be less likely to RTA.
Cohort study; Level of evidence, 2.
There were 862 patients who underwent a revision ACL reconstruction (rACLR) and self-reported physical activity at any level preoperatively. Those who did not RTA reported no activity 2 years after revision. Baseline data included patient characteristics, surgical history and characteristics, and PROs: International Knee Documentation Committee questionnaire, Marx Activity Rating Scale, Knee injury and Osteoarthritis Outcome Score, and the Western Ontario and McMaster Universities Osteoarthritis Index. A binary indicator was used to identify patients with same/better PROs versus worse outcomes compared with baseline, quantifying the magnitude of change in each direction, respectively. Multivariable regression models were used to evaluate risk factors for not returning to activity, the association of 2-year PROs after rACLR surgery by RTA status, and whether each PRO and RTA status differed by participation level.
At 2 years postoperatively, approximately 15% did not RTA, with current smokers (adjusted odds ratio [aOR] = 3.3; = .001), female patients (aOR = 2.9; < .001), recreational participants (aOR = 2.0; = .016), and those with a previous medial meniscal excision (aOR = 1.9; = .013) having higher odds of not returning. In multivariate models, not returning to activity was significantly associated with having worse PROs at 2 years; however, no clinically meaningful differences in PROs at 2 years were seen between participation levels.
Recreational-level participants were twice as likely to not RTA compared with those participating at higher levels. Within a previously active cohort, no RTA was a significant predictor of lower PROs after rACLR. However, among patients who did RTA after rACLR, approximately 20% reported lower outcome scores. Most patients with rACLR who were active at baseline improved over time; however, patients who reported worse outcomes at 2 years had a clinically meaningful decline across all PROs.
与初次前交叉韧带（ACL）重建的患者相比，接受 ACL 翻修的患者术后在经过验证的膝关节问卷中报告的结局评分较低。在以前活跃的人群中，尚不清楚患者报告的结局（PROs）是否与重返活动（RTA）相关，或者是否因运动参与水平而异（高水平与娱乐运动员）。
个别 RTA 将与使用经过验证的 PROs 测量的改善结局（即膝关节症状、疼痛、功能减少）相关。与高水平运动员相比，娱乐运动员报告的 PROs 较低，并且不太可能 RTA。
队列研究；证据水平，2。
共有 862 名接受 ACL 翻修重建（rACLR）的患者在术前报告了任何水平的体力活动。那些没有 RTA 的患者在 rACL 后 2 年没有报告任何活动。基线数据包括患者特征、手术史和特征以及 PROs：国际膝关节文献委员会问卷、Marx 活动评分量表、膝关节损伤和骨关节炎结局评分以及安大略西部和麦克马斯特大学骨关节炎指数。使用二进制指标来识别与基线相比 PROs 相同/更好与结局更差的患者，分别量化每个方向的变化幅度。多变量回归模型用于评估不恢复活动的危险因素、rACLR 手术后 2 年 PROs 与 RTA 状态的关系，以及每个 PRO 和 RTA 状态是否因参与水平而异。
术后 2 年，约有 15%的患者未进行 RTA，其中吸烟者（校正优势比 [aOR] = 3.3； =.001）、女性患者（aOR = 2.9； <.001）、娱乐运动员（aOR = 2.0； =.016）和那些以前接受过内侧半月板切除术的患者（aOR = 1.9； =.013）的 RTA 几率更高。在多变量模型中，未恢复活动与 2 年时 PROs 更差显著相关；然而，在参与水平之间，2 年时的 PROs 没有临床意义上的差异。
与高水平运动员相比，娱乐级别的参与者 RTA 的可能性是其两倍。在以前活跃的队列中，rACLR 后无 RTA 是 PROs 降低的显著预测因素。然而，在接受 rACLR 后进行 RTA 的患者中，约有 20%报告的结局评分较低。大多数在基线时活跃的 rACLR 患者随着时间的推移而有所改善；然而，在 2 年时报告结局更差的患者在所有 PROs 中都有明显的下降。
