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MARS group identifies revision ACL reconstruction risk factors that help predict PROs
KOOS baseline score, time since last reconstruction and Marx score had the most impact on PROs.
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TORONTO — Several positive and negative risk factors related to revision ACL reconstruction were found to predict patient-reported outcomes. Awareness of those factors may help improve outcomes or assist orthopedic surgeons with patient counseling based on whether the factors are modifiable, according to a presenter at the American Orthopaedic Society for Sports Medicine Annual Meeting, here.
Rick W. Wright, MD, said, “Marx scores were most impacted in a positive direction by a high baseline activity, male gender, young age and not smoking. Strongest negative predictor was use of biologic enhancement and the use of allograft for the revision.”
Wright was among 83 surgeons at 52 sites in the Multicenter ACL Revision Study (MARS) group who enrolled patients who were undergoing revision ACL reconstruction in a study in 2006. They collected baseline demographics, information about the surgical technique and pathology, and patient-reported outcomes (PROs) at baseline and 2-year follow-up. The researchers then used multivariate regression models to determine risk factors related to IKDC, KOOS and Marx activity rating scores.
Overall, 1,205 patients (58% were men) met the inclusion criteria for the study. Wright and colleagues obtained 2-year follow-up questionnaires and phone follow-up from 82% and 92% of patients, respectively, which they used to document ACL re-ruptures and subsequent surgeries.
For the IKDC score, they found the significant risk factors for predictable PROs included positive higher baseline Marx and IKDC scores, male gender, not smoking and longer time since last ACL reconstruction. Negative risk factors included previous lateral meniscectomy surgery, grade 3 lateral femoral condyle chondrosis and grades 3 and 4 tibial plateau chondrosis.
For nearly all the KOOS subscales, results showed baseline score and Marx score had the greatest impact on PROs. These were among the positive risk factors for all the KOOS subscales, as well as a longer time since ACL reconstruction.
Wright and colleagues found negative risk factors for the KOOS subscales included previous medial and/or lateral meniscectomy and previous lateral meniscectomy. The KOOS symptom subscale and KOOS sports and recreation subscales had a negative predictor of grade 3 and grade 4 medial tibial plateau chondrosis, researchers noted.
In addition, results showed KOOS ADL score was a negative risk factor of grade 3 and grade 4 trochlear groove chondrosis.
“Positive KOOS predictors varied somewhat by subscale measure,” Wright said. “Odds ratios and P values showed that baseline score, time since last reconstruction and Marx score were most impactful. Previous lateral or medial meniscectomy and trochlear groove chondrosis were the most consistent negative predictors.” – by Casey Tingle
- Reference:
- MARS Group. Paper #158. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 20-23, 2017; Toronto.
- For more information:
- Rick W. Wright, MD, can be reached at Washington University and Barnes-Jewish Orthopedic Center, 14532 S. Outer 40 Dr., Chesterfield, MO 63017; email: williamsdia@wustl.edu.
Disclosure: Wright reports he receives support from the NIH (NIAMS and INCHD).