Most patients who underwent surgery to repair and rebuild an anterior cruciate ligament (ACL) tear showed significant improvement in physical function at 2 years, which continued for at least 6 years following surgery, according to a study published April 1 in the Journal of Bone & Joint Surgery. Younger patient age, lower body mass index, and having the remnants of the torn ACL completely excised during surgery were among the strongest predictors of positive, long-term outcome.
In this study, researchers reviewed and evaluated the outcomes of 1,411 patients (44% female; average patient age at enrollment, 23) who underwent ACL surgery between 2002 and 2004 at four major medical centers. Each patient completed questionnaires that assessed health, well-being, and function prior to surgery, and again at 2 and 6 years after surgery.
“We found that health-related quality of life was significantly improved following ACL reconstruction, and this improvement was still present 6 years following surgery,” said lead study author Warren R. Dunn, MD, MPH, an orthopedic surgeon at the University of Wisconsin in Madison.
Warren R. Dunn, MD, MPH
At baseline, the average physical health score was 41.9 and the mean mental health score was 51.7. At 2 years after surgery, the physical and mental health scores were stable at 53.6 and 52 points, respectively, and 54 and 52.4 points at year 6.
Among the study’s findings:
• ACL reconstruction resulted in large improvements in the physical function scores, with a mean improvement of 12 points (out of 100) at 2 years and 6 years following surgery.
• At 6 years following ACL surgery, patients gained a mean 5.3 quality-adjusted life years.
• Baseline activity level was a significant predictor of mental health scores, but not physical function scores.
• Predictors of worse postoperative outcomes were a shorter follow-up time post-surgery, revision ACL reconstruction, smoking at baseline, fewer years of education, and damage to the cartilage under the chondromalacia patella.
• Physical function continued to improve over the long term following reconstruction. Patients requiring a revision reconstruction did not fare as well as patients undergoing a single reconstruction.
• Mental health scores over the 6-year period did not significantly change, but scores consistently remained above the population norm of 50 points.
“The predictors for good and poorer outcomes may be helpful when counseling patients who are considering ACL surgery,” stated Dr. Dunn.