PMID- 37065184
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230418
IS  - 2325-9671 (Print)
IS  - 2325-9671 (Electronic)
IS  - 2325-9671 (Linking)
VI  - 11
IP  - 4
DP  - 2023 Apr
TI  - Propensity for Clinically Meaningful Improvement and Surgical Failure After 
      Anterior Cruciate Ligament Repair.
PG  - 23259671221146815
LID - 10.1177/23259671221146815 [doi]
LID - 23259671221146815
AB  - BACKGROUND: Primary repair of the anterior cruciate ligament (ACL) confers an 
      alternative to ACL reconstruction in appropriately selected patients. PURPOSE: To 
      prospectively assess survivorship and to define the clinically meaningful 
      outcomes after ACL repair. STUDY DESIGN: Case series; Level of evidence, 4. 
      METHODS: Included were consecutive patients with Sherman grade 1-2 tears who 
      underwent primary ACL repair with or without suture augmentation between 2017 and 
      2019. Patient-reported outcomes (Lysholm, Tegner, International Knee 
      Documentation Committee, Western Ontario and McMaster Universities Osteoarthritis 
      Index, and Knee injury and Osteoarthritis Outcome Score [KOOS] subscales) were 
      collected preoperatively and at 6 months, 1 year, and 2 years postoperatively. 
      The minimal clinically important difference (MCID) was calculated using a 
      distribution-based method, whereas the Patient Acceptable Symptom State (PASS) 
      and substantial clinical benefit (SCB) were calculated using an anchor-based 
      method. Plain radiographs and magnetic resonance imaging (MRI) were obtained at 6 
      months, 1 year, and 2 years postoperatively. RESULTS: A total of 120 patients 
      were included. The overall failure rate was 11.3% at 2 years postoperatively. 
      Changes in outcome scores required to achieve the MCID ranged between 5.1 and 
      14.3 at 6 months, 4.6 and 8.4 at 1 year, and 4.7 and 11.9 at 2 years 
      postoperatively. Thresholds for PASS achievement ranged between 62.5 and 89 at 6 
      months, 75 and 89 at 1 year, and 78.6 and 93.2 at 2 years postoperatively. 
      Threshold scores (absolute/change based) for achieving the SCB ranged between 
      82.8 and 96.4/17.7 and 40.1 at 6 months, between 94.7 and 100/23 and 45 at 1 
      year, and between 95.3 and 100/29.4 and 45 at 2 years. More patients achieved the 
      MCID and PASS at 1 year compared with 6 months and 2 years. For SCB, this trend 
      was also observed for non-KOOS outcomes, while for KOOS subdomains, more patients 
      achieved the SCB at 2 years. High-intensity signal of the ACL repair (odds ratio 
      [OR], 31.7 [95% CI, 1.5-73.4]; P = .030) and bone contusions on MRI (OR, 4.2 [95% 
      CI, 1.7-25.2]; P = .041) at 1 year postoperatively were independently associated 
      with increased risk of ACL repair failure. CONCLUSION: The rate of clinically 
      meaningful outcome improvement was high early after ACL repair, with the greatest 
      proportion of patients achieving the MCID, PASS, and SCB at 1 year 
      postoperatively. Bone contusions involving the posterolateral tibia and lateral 
      femoral condyle as well as high repair signal intensity at 1 year postoperatively 
      were independent predictors of failure at 2 years postoperatively.
CI  - (c) The Author(s) 2023.
FAU - Batista, Jorge Pablo
AU  - Batista JP
AD  - Centro Artroscopico Jorge Batista SA, Buenos Aires, Argentina.
FAU - Maestu, Rodrigo
AU  - Maestu R
AD  - Centro de Tratamiento de Enfermedades Articulares, Buenoa Aires, Argentina.
FAU - Barbier, Jose
AU  - Barbier J
AD  - Centro Artroscopico Jorge Batista SA, Buenos Aires, Argentina.
FAU - Chahla, Jorge
AU  - Chahla J
AD  - Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University 
      Medical Center, Chicago, Illinois, USA.
FAU - Kunze, Kyle N
AU  - Kunze KN
AD  - Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New 
      York, USA.
LA  - eng
PT  - Journal Article
DEP - 20230412
PL  - United States
TA  - Orthop J Sports Med
JT  - Orthopaedic journal of sports medicine
JID - 101620522
PMC - PMC10102942
OTO - NOTNLM
OT  - ACL
OT  - MCID
OT  - PASS
OT  - SCB
OT  - clinical outcomes
OT  - repair
COIS- One or more of the authors has declared the following potential conflict of 
      interest or source of funding: R.M. has received consulting fees from Smith & 
      Nephew. J.C. has received education payments from Arthrex and Smith & Nephew; 
      consulting fees from Arthrex, DePuy Synthes, Linvatec, and Smith & Nephew; 
      speaking fees from Linvatec; and hospitality payments from Stryker. AOSSM checks 
      author disclosures against the Open Payments Database (OPD). AOSSM has not 
      conducted an independent investigation on the OPD and disclaims any liability or 
      responsibility relating thereto.
EDAT- 2023/04/18 06:00
MHDA- 2023/04/18 06:01
PMCR- 2023/04/12
CRDT- 2023/04/17 03:53
PHST- 2022/09/03 00:00 [received]
PHST- 2022/10/11 00:00 [accepted]
PHST- 2023/04/18 06:01 [medline]
PHST- 2023/04/17 03:53 [entrez]
PHST- 2023/04/18 06:00 [pubmed]
PHST- 2023/04/12 00:00 [pmc-release]
AID - 10.1177_23259671221146815 [pii]
AID - 10.1177/23259671221146815 [doi]
PST - epublish
SO  - Orthop J Sports Med. 2023 Apr 12;11(4):23259671221146815. doi: 
      10.1177/23259671221146815. eCollection 2023 Apr.