Prediction of patient-reported outcome after single-bundle anterior cruciate ligament reconstruction.
OBJECTIVE
The purpose of this study was to identify preoperative and intraoperative factors that predict patient-oriented outcome as measured by the International Knee Documentation Committee (IKDC) Subjective Knee Form after anterior cruciate ligament (ACL) reconstruction.


METHODS
We identified 402 subjects who had undergone primary single-bundle arthroscopic ACL reconstruction at a mean follow-up of 6.3 years (range, 2 to 15 years). The IKDC Subjective Knee Form was used to measure patient-reported outcome and was dichotomized as above or below the patient-specific age- and gender-matched population mean. Potential predictor variables included subject demographics, activity level before surgery, previous meniscectomy, and surgical variables. Multivariate logistic regression analysis was performed to identify the best subset of predictors for determining the likelihood that the IKDC score was better than the age- and gender-matched population mean.


RESULTS
The dichotomized IKDC score was associated with body mass index (BMI), smoking status, education, previous medial meniscectomy, and medial chondrosis at the time of ACL reconstruction. The multivariate model containing only factors known before surgery included BMI and smoking status. Subjects with a BMI greater than 30 kg/m(2) had 0.35 times the odds of success as subjects with a normal BMI. Subjects who smoked had 0.36 times the odds of success as subjects who did not smoke. A model including medial chondrosis at the time of surgery had a slightly higher discriminatory power (area under the receiver operating characteristic curve, 0.65 v 0.61) and negative predictive value (71.4% v 60.0%) but similar positive predictive power (86.3% v 85.9%).


CONCLUSIONS
Lower patient-reported outcome after ACL reconstruction was strongly associated with obesity, smoking, and severe chondrosis at the time of surgery.


METHODS
Level III, prognostic case-control study.
Kowalchuk
Deborah A
DA
Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Harner
Christopher D
CD
Fu
Freddie H
FH
Irrgang
James J
JJ
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D055815:Young Adult