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17.07.2017 | Symposium: Improving Care for Patients With ACL Injuries: A Team Approach

Younger Patients and Men Achieve Higher Outcome Scores Than Older Patients and Women After Anterior Cruciate Ligament Reconstruction

verfasst von: Kate E. Webster, PhD, Julian A. Feller, FRACS

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 10/2017

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Abstract

Background

There is some evidence that functional performance and validated outcome scores differ according to the gender, age, and sport participation status of a patient after anterior cruciate ligament (ACL) reconstruction. However, the impact of these three factors, and interaction among them, has not been studied across a large relatively homogeneous group of patients to better elucidate their impact.

Questions/purposes

We reviewed a large cohort of patients who had undergone ACL reconstruction to determine if ROM, knee laxity, objective performance measures, and validated outcome scores differed according to (1) gender; (2) age; and (3) sport participation status.

Methods

This was a retrospective analysis of prospectively collected data. Between 2007 and 2016, we performed 3452 single-bundle ACL reconstructions in patients who participated in sport before ACL injury. Of those, complete followup (including preoperative scores and scores at 1 year after surgery; mean, 14 months; range, 12–20 months) was available on 2672 (77%) of patients. Those lost to followup and those accounted for were not different in terms of age, gender, and sports participation at baseline. The study group consisted of 1726 (65%) men and 946 (35%) women with a mean ± SD age of 28 ± 10 years. For these patients, the following measures were obtained: knee ROM (flexion and extension deficit), instrumented knee laxity, single and triple hop for distance limb symmetry index (LSI), International Knee Documentation Committee (IKDC) subjective evaluation, and Single Assessment Numeric Evaluation score. Mean scores and measures of variability were calculated for each outcome measure. Comparisons were made among gender, age, and sport status.

Results

Men had less knee laxity after reconstruction (men 1.1 ± 2.2 mm, women 1.3 ± 2.4 mm; mean difference 0.2 mm [0.1–0.4], p < 0.001), greater limb symmetry (single limb hop men: 94% ± 12%, women 91% ± 13%, mean difference 3% [2%–4%], p < 0.001), and higher IKDC scores than did women (men 84 ± 12, women 82 ± 12, mean difference 2 [1–3], p < 0.001). With the exception of instrumented laxity, all outcome measures showed reduced deficits and higher scores in younger patients. This was most marked for LSI scores between the youngest and oldest aged patient groups (crossover hop: < 16 years 99% ± 10%, > 45 years 90% ± 16%, mean difference: 9 [5–11], p < 0.001). Patients who had returned to their preinjury sport also scored higher and had smaller deficits for all outcomes except ROM compared with patients who had not returned to sport at the time of followup (IKDC subjective: returned 90 ± 9, no sport 79 ± 12, mean difference 11 points [9–12], p < 0.001; single limb hop: returned 97 ± 10, no sport 91 ± 14, mean difference 6% [5%–7%], p < 0.001).

Conclusions

This study showed that some of the most commonly used functional performance and validated clinical scores for ACL reconstruction are superior for patients who are younger, male, and have returned to preinjury sport. Reference to these data allows clinicians to more effectively evaluate a patient based on their age, gender, and sport status when making return to sport and rehabilitation decisions.

Level of Evidence

Level III, therapeutic study.
Literatur
1.
Zurück zum Zitat Ageberg E, Forssblad M, Herbertsson P, Roos EM. Sex differences in patient-reported outcomes after anterior cruciate ligament reconstruction: data from the Swedish knee ligament register. Am J Sports Med. 2010;38:1334–1342.CrossRefPubMed Ageberg E, Forssblad M, Herbertsson P, Roos EM. Sex differences in patient-reported outcomes after anterior cruciate ligament reconstruction: data from the Swedish knee ligament register. Am J Sports Med. 2010;38:1334–1342.CrossRefPubMed
2.
Zurück zum Zitat Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis incluing aspects of physcial functioning and contextual factors. Br J Sports Med. 2014;48:1543–1552.CrossRefPubMed Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis incluing aspects of physcial functioning and contextual factors. Br J Sports Med. 2014;48:1543–1552.CrossRefPubMed
3.
Zurück zum Zitat Ardern L, Webster KE, Taylor NF, Feller JA. Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med. 2011;39:538–543.CrossRefPubMed Ardern L, Webster KE, Taylor NF, Feller JA. Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med. 2011;39:538–543.CrossRefPubMed
4.
Zurück zum Zitat Dodwell ER, Lamont LE, Green DW, Pan TJ, Marx RG, Lyman S. 20 years of pediatric anterior cruciate ligament reconstruction in New York State. Am J Sports Med. 2014;42:675–680.CrossRefPubMed Dodwell ER, Lamont LE, Green DW, Pan TJ, Marx RG, Lyman S. 20 years of pediatric anterior cruciate ligament reconstruction in New York State. Am J Sports Med. 2014;42:675–680.CrossRefPubMed
5.
Zurück zum Zitat Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50:804–808.CrossRefPubMedPubMedCentral Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50:804–808.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Hewett TE, Myer GD, Ford KR. Anterior cruciate ligament injuries in female athletes: Part 1, mechanisms and risk factors. Am J Sports Med. 2006;34:299–311.CrossRefPubMed Hewett TE, Myer GD, Ford KR. Anterior cruciate ligament injuries in female athletes: Part 1, mechanisms and risk factors. Am J Sports Med. 2006;34:299–311.CrossRefPubMed
7.
Zurück zum Zitat Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelbourne KD. Development and validation of the International Knee Documentation Committee subjective knee form. Am J Sports Med. 2001;29:600–613.CrossRefPubMed Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelbourne KD. Development and validation of the International Knee Documentation Committee subjective knee form. Am J Sports Med. 2001;29:600–613.CrossRefPubMed
8.
Zurück zum Zitat Logerstedt D, S DS, Grindem H, Lynch A, Eitzen I, Engebretsen L, Risberg MA, Axe MJ, Snyder-Mackler L. Self-reported knee function can identify athletes who fail return-to-activity criteria up to 1 year after anterior cruciate ligament reconstruction: a delaware-oslo ACL cohort study. J Orthop Sports Phys Ther. 2014;44:914–923. Logerstedt D, S DS, Grindem H, Lynch A, Eitzen I, Engebretsen L, Risberg MA, Axe MJ, Snyder-Mackler L. Self-reported knee function can identify athletes who fail return-to-activity criteria up to 1 year after anterior cruciate ligament reconstruction: a delaware-oslo ACL cohort study. J Orthop Sports Phys Ther. 2014;44:914–923.
9.
Zurück zum Zitat Mall NA, Chalmers PN, Moric M, Tanaka MJ, Cole BJ, Bach BRJ, Paletta GAJ. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med. 2014;42:2363–2370.CrossRefPubMed Mall NA, Chalmers PN, Moric M, Tanaka MJ, Cole BJ, Bach BRJ, Paletta GAJ. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med. 2014;42:2363–2370.CrossRefPubMed
10.
Zurück zum Zitat Morgan MD, Salmon LJ, Waller A, Roe JP, Pinczewski LA. Fifteen-year survival of endoscopic anterior cruciate ligament reconstruction in patients aged 18 years and younger. Am J Sports Med. 2016;44:384–392.CrossRefPubMed Morgan MD, Salmon LJ, Waller A, Roe JP, Pinczewski LA. Fifteen-year survival of endoscopic anterior cruciate ligament reconstruction in patients aged 18 years and younger. Am J Sports Med. 2016;44:384–392.CrossRefPubMed
11.
Zurück zum Zitat Nawasreh Z, Logerstedt D, Cummer K, Axe MJ, Risberg MA, Snyder-Mackler L. Do patients failing return-to-activity criteria at 6 months after anterior cruciate ligament reconstruction continue demonstrating deficits at 2 years? Am J Sports Med. 2017;45:1037–1048.CrossRefPubMed Nawasreh Z, Logerstedt D, Cummer K, Axe MJ, Risberg MA, Snyder-Mackler L. Do patients failing return-to-activity criteria at 6 months after anterior cruciate ligament reconstruction continue demonstrating deficits at 2 years? Am J Sports Med. 2017;45:1037–1048.CrossRefPubMed
12.
Zurück zum Zitat Noyes FR, Barber SD, Mangine RE. Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med. 1991;19:513–518.CrossRefPubMed Noyes FR, Barber SD, Mangine RE. Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med. 1991;19:513–518.CrossRefPubMed
13.
Zurück zum Zitat Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Am J Sports Med. 2014;42:1567–1573.CrossRefPubMedPubMedCentral Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Am J Sports Med. 2014;42:1567–1573.CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy. 2007;23:1320–1325.CrossRefPubMed Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy. 2007;23:1320–1325.CrossRefPubMed
15.
Zurück zum Zitat Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, Mandelbaum B, Micheli L, Myklebust G, Roos E, Roos H, Schamasch P, Shultz S, Werner S, Wojtys E, Engebretsen L. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med. 2008;42:394–412.CrossRefPubMedPubMedCentral Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, Mandelbaum B, Micheli L, Myklebust G, Roos E, Roos H, Schamasch P, Shultz S, Werner S, Wojtys E, Engebretsen L. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med. 2008;42:394–412.CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Sachs RA, Daniel DM, Stone ML, Garfein RF. Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sports Med. 1989;17:760–765.CrossRefPubMed Sachs RA, Daniel DM, Stone ML, Garfein RF. Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sports Med. 1989;17:760–765.CrossRefPubMed
17.
Zurück zum Zitat Shelbourne KD, Barnes AF, Gray T. Correlation of a Single Assessment Numeric Evaluation (SANE) rating with modified Cincinnati knee rating system and IKDC subjective total scores for patients after ACL reconstruction or knee arthroscopy. Am J Sports Med. 2012;40:2487–2491.CrossRefPubMed Shelbourne KD, Barnes AF, Gray T. Correlation of a Single Assessment Numeric Evaluation (SANE) rating with modified Cincinnati knee rating system and IKDC subjective total scores for patients after ACL reconstruction or knee arthroscopy. Am J Sports Med. 2012;40:2487–2491.CrossRefPubMed
18.
Zurück zum Zitat Sutton KM, Bullock JM. Anterior cruciate ligament rupture: differences between males and females. J Am Acad Orthop Surg. 2013;21:41–50.CrossRefPubMed Sutton KM, Bullock JM. Anterior cruciate ligament rupture: differences between males and females. J Am Acad Orthop Surg. 2013;21:41–50.CrossRefPubMed
19.
Zurück zum Zitat Tan SH, Lau BP, Khin LW, Lingaraj K. The importance of patient sex in the outcomes of anterior cruciate ligament reconstructions: a systematic review and meta-analysis. Am J Sports Med. 2016; 44:242–54. Tan SH, Lau BP, Khin LW, Lingaraj K. The importance of patient sex in the outcomes of anterior cruciate ligament reconstructions: a systematic review and meta-analysis. Am J Sports Med. 2016; 44:242–54.
20.
Zurück zum Zitat Webster KE, Feller JA. Exploring the high reinjury rate in younger patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med. 2016;44:2827–2832.CrossRefPubMed Webster KE, Feller JA. Exploring the high reinjury rate in younger patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med. 2016;44:2827–2832.CrossRefPubMed
21.
Zurück zum Zitat Webster KE, Feller JA, Leigh WB, Richmond AK. Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. Am J Sports Med. 2014;42:641–647.CrossRefPubMed Webster KE, Feller JA, Leigh WB, Richmond AK. Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. Am J Sports Med. 2014;42:641–647.CrossRefPubMed
22.
Zurück zum Zitat Williams GN, Gangel TJ, Arciero RA, Uhorchak JM, Taylor DC. Comparison of the single assessment numeric evaluation method and two shoulder rating scales: outcomes measures after shoulder surgery. Am J Sports Med. 1999;27:214–221.CrossRefPubMed Williams GN, Gangel TJ, Arciero RA, Uhorchak JM, Taylor DC. Comparison of the single assessment numeric evaluation method and two shoulder rating scales: outcomes measures after shoulder surgery. Am J Sports Med. 1999;27:214–221.CrossRefPubMed
23.
Zurück zum Zitat Williams GN, Taylor DC, Gangel TJ, Uhorchak JM, Arciero RA. Comparison of the single assessment numeric evaluation method and the Lysholm score. Clin Orthop Relat Res. 2000;373:184–192.CrossRef Williams GN, Taylor DC, Gangel TJ, Uhorchak JM, Arciero RA. Comparison of the single assessment numeric evaluation method and the Lysholm score. Clin Orthop Relat Res. 2000;373:184–192.CrossRef
Metadaten
Titel
Younger Patients and Men Achieve Higher Outcome Scores Than Older Patients and Women After Anterior Cruciate Ligament Reconstruction
verfasst von
Kate E. Webster, PhD
Julian A. Feller, FRACS
Publikationsdatum
17.07.2017
Verlag
Springer US
Erschienen in
Clinical Orthopaedics and Related Research® / Ausgabe 10/2017
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-017-5418-2

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