PMID- 28727937 OWN - NLM STAT- MEDLINE DCOM- 20180219 LR - 20220408 IS - 1552-3365 (Electronic) IS - 0363-5465 (Linking) VI - 45 IP - 12 DP - 2017 Oct TI - Preoperative Short Form Health Survey Score Is Predictive of Return to Play and Minimal Clinically Important Difference at a Minimum 2-Year Follow-up After Anterior Cruciate Ligament Reconstruction. PG - 2784-2790 LID - 10.1177/0363546517714472 [doi] AB - BACKGROUND: There is increased interest in understanding the preoperative determinants of postoperative outcomes. Return to play (RTP) and the patient-reported minimal clinically important difference (MCID) are useful measures of postoperative outcomes after anterior cruciate ligament reconstruction (ACLR). PURPOSE: To define the MCID after ACLR and to investigate the role of preoperative outcome scores for predicting the MCID and RTP after ACLR. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: There were 294 active athletes enrolled as part of an institutional ACL registry with a minimum 2-year follow-up who were eligible for inclusion. A questionnaire was administered to elicit factors associated with RTP. Patient demographic and clinical data as well as patient-reported outcome measures were captured as part of the registry. Outcome measures included the International Knee Documentation Committee (IKDC) subjective knee evaluation form, Lysholm scale, and 12-Item Short Form Health Survey (SF-12) physical component summary (PCS) and mental component summary (MCS). Preoperative outcome score thresholds predictive of RTP were determined using a receiver operating characteristic (ROC) with area under the curve (AUC) analysis. The MCID was calculated using a distribution-based method. Multivariable logistic models were fitted to identify predictors for achieving the MCID and RTP. RESULTS: At a mean (+/-SD) follow-up of 3.7 +/- 0.7 years, 231 patients were included from a total 294 eligible patients. The mean age and body mass index were 26.7 +/- 12.5 years and 23.7 +/- 3.2 kg/m(2), respectively. Of the 231 patients, 201 (87.0%) returned to play at a mean time of 10.1 months. Two-year postoperative scores on all measures were significantly increased from preoperative scores (IKDC: 50.1 +/- 15.6 to 87.4 +/- 10.7; Lysholm: 61.2 +/- 18.1 to 89.5 +/- 10.4; SF-12 PCS: 41.5 +/- 9.0 to 54.7 +/- 4.6; SF-12 MCS: 53.6 +/- 8.1 to 55.7 +/- 5.7; P < .001 for all). The corresponding MCID values were 9.0 (IKDC), 10.0 (Lysholm), 5.1 (SF-12 PCS), and 4.3 (SF-12 MCS). Preoperative score thresholds predictive of RTP were the following: IKDC, 60.9; Lysholm, 57.0; SF-12 PCS, 42.3; and SF-12 MCS, 48.3. These thresholds were not independently predictive but achieved significance as part of the multivariable analysis. In the multivariable analysis for RTP, preoperative SF-12 PCS scores above 42.3 (odds ratio [OR], 2.73; 95% CI, 1.09-7.62) and SF-12 MCS scores above 48.3 (OR, 4.41; 95% CI, 1.80-10.98) were predictive for achieving RTP; an ACL allograft (OR, 0.26; 95% CI, 0.06-1.00) was negatively predictive of RTP. In the multivariable analysis for the MCID, patients with higher preoperative scores were less likely to achieve the MCID ( P < .0001); however, a higher preoperative SF-12 MCS score was predictive of achieving the MCID on the IKDC form (OR, 1.27; 95% CI, 1.11-1.52) and Lysholm scale (OR, 1.08; 95% CI, 1.00-1.16). Medial meniscal injuries, older age, and white race were also associated with a decreased likelihood for achieving the MCID. CONCLUSION: Preoperative SF-12 MCS and PCS scores were predictive of RTP after ACLR; patients scoring above 42.3 on the SF-12 PCS and 48.3 on the SF-12 MCS were more likely to achieve RTP. Additionally, we defined the MCID after ACLR and found that higher SF-12 MCS scores were predictive of achieving the MCID on knee-specific questionnaires. FAU - Nwachukwu, Benedict U AU - Nwachukwu BU AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA. FAU - Chang, Brenda AU - Chang B AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA. FAU - Voleti, Pramod B AU - Voleti PB AD - Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA. FAU - Berkanish, Patricia AU - Berkanish P AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA. FAU - Cohn, Matthew R AU - Cohn MR AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA. FAU - Altchek, David W AU - Altchek DW AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA. FAU - Allen, Answorth A AU - Allen AA AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA. FAU - Williams, Riley J Rd AU - Williams RJ Rd AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA. LA - eng PT - Journal Article DEP - 20170720 PL - United States TA - Am J Sports Med JT - The American journal of sports medicine JID - 7609541 SB - IM MH - Adolescent MH - Adult MH - Anterior Cruciate Ligament/*surgery MH - Anterior Cruciate Ligament Reconstruction MH - Case-Control Studies MH - Female MH - Follow-Up Studies MH - Health Surveys MH - Humans MH - Knee Injuries/*surgery MH - Knee Joint/surgery MH - Male MH - Middle Aged MH - Minimal Clinically Important Difference MH - Postoperative Period MH - Preoperative Period MH - Return to Sport MH - Surveys and Questionnaires MH - Treatment Outcome MH - Young Adult OTO - NOTNLM OT - SF-12 OT - anterior cruciate ligament reconstruction OT - health-related quality of life OT - minimal clinically important difference OT - patient-reported outcome OT - return to play EDAT- 2017/07/21 06:00 MHDA- 2018/02/20 06:00 CRDT- 2017/07/21 06:00 PHST- 2017/07/21 06:00 [pubmed] PHST- 2018/02/20 06:00 [medline] PHST- 2017/07/21 06:00 [entrez] AID - 10.1177/0363546517714472 [doi] PST - ppublish SO - Am J Sports Med. 2017 Oct;45(12):2784-2790. doi: 10.1177/0363546517714472. Epub 2017 Jul 20.