Patient-reported outcomes 1 to 5 years after ACL reconstruction: effect of combined injury, and associations with MRI-defined osteoarthritis features Academic Article uri icon


  • OBJECTIVE:Persistent symptoms and poor quality of life (QoL) are common following anterior cruciate ligament reconstruction (ACLR). We aimed to determine the influence of a combined ACL injury (i.e., concomitant meniscectomy and/or arthroscopic chondral defect at the time of ACLR and/or secondary injury/surgery to ACLR knee) and MRI-defined cartilage defects, bone marrow lesions (BMLs) and meniscal lesions on patient-reported outcomes (PROs) 1- to 5-years post-ACLR METHODS: 80 participants (50 men) aged 32±14 years completed the Knee injury and OA Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) questionnaire, and 3T MRI assessment at 1- and 5-years post-ACLR. Median PRO scores were compared between isolated and combined ACL injuries, and with published normative values. Multivariate regression evaluated the association between compartment-specific MRI cartilage, BMLs and meniscal lesions, and PROs at 1- and 5-years. RESULTS:Individuals with a combined injury had significantly worse KOOS-Sport, and IKDC scores at 1-year, and worse KOOS-Pain, KOOS-Symptoms, KOOS-QoL, and IKDC scores at 5-years, compared to those with an isolated injury. Whilst no feature on MRI was associated with PROs cross-sectionally at 1-year, patellofemoral cartilage defects at 1-year were significantly associated with worse 5-year KOOS-Symptoms (β: -9.79; 95%CI:-16.67, -2.91), KOOS-Sport (β: -7.94; 95%CI:-15.27, -0.61), KOOS-QoL (β: -8.29; 95%CI:-15.28, -1.29) and IKDC (β: -4.79; 95%CI:-9.34, -0.24). Patellofemoral cartilage defects at 5-years were also significantly associated with worse 5-year KOOS-Symptoms (β: -6.86; 95%CI:-13.49, -0.24) and KOOS-QoL (β: -11.71; 95%CI:-19.08, -4.33). CONCLUSION:Combined injury, and patellofemoral cartilage defects on MRI are associated with poorer long-term outcomes. Clinicians should be vigilant to these individuals, who may benefit from targeted interventions to improve QoL and optimise symptoms. This article is protected by copyright. All rights reserved.

publication date

  • 2019