Background

Anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure, and patient reported outcome measures (PROMs) are often used to measure long term success of treatment. The study’s goal was to investigate factors associated with clinically meaningful outcomes after ACL reconstruction, as measured by the Patient Acceptable Symptom State (PASS). Additionally, the study aimed to evaluate differences in factors between male and female patients. 


Methods
Patients above the age of 14 who received ACL reconstructions at a single institution were identified retrospectively. Data on demographics, operative notes, and medical history were collected from electronic medical records. These patients were followed up a minimum of two years after surgery with surveys that included an International Knee Documentation Committee (IKDC) Subjective Knee Evaluation form and asked about subsequent diagnoses and surgeries. PASS was defined an IKDC score off 75.9 or higher based on the threshold identified by Muller et al. Univariate logistic regression was performed to identify predictors of achieving PASS, and variables were selected for inclusion in a multivariable logistic regression model based on univariate analysis, prior literature, and clinical relevance. The multivariate regression was stratified by sex. 


Results
A total of 479 patients were included in the study with a mean follow up of 10 ± 5 years. The cohort had an average age of 38 and was 57% female. PASS was achieved by 68% of patients and 9 patients underwent ACL revision surgery. Upon univariate analysis, age, BMI, meniscectomy, revisions and skiing were identified as potential predictors for the multivariable model. Multivariable analysis found that higher BMI (OR 0.95[0.91, 0.99], p = 0.019) and revisions (OR 0.2 [0.04, 0.78], p = 0.025) had independent, negative associations with achievement of PASS. Participation in skiing (OR 1.81 [1.12,2.99], p = 0.018) was found to be positively and independently associated with achieving PASS. Among males, higher BMI (0.9 [0.83, 0.99], p = 0.023) was negatively associated with PASS and participation in skiing (3.52 [1.63, 8.38], p = .002) was positively associated with PASS. Among females, revisions (OR 0.09 [0.00,0.63], p = 0.034) were negatively associated with achievement of PASS. 

Conclusion

Sex differences were observed in factors associated with achieving PASS after ACL reconstruction. Among males, BMI and skiing were found to be associated with PASS, while among females, revision surgery was a significant predictor. These results highlight the need for further investigation of sex specific factors in ACL reconstruction outcomes. 


Sex-specific factors associated with achieving Patient Acceptable Symptom State (PASS) at a mean ten year follow up after anterior cruciate ligament (ACL) reconstruction.

Orthopaedic Surgery (Clinical and Transitional Research)

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Sex-specific factors associated with achieving Patient Acceptable Symptom State (PASS) at a mean ten year follow up after anterior cruciate ligament (ACL) reconstruction.

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