title: The prognosis and predictors of sports function and activity at minimum 6 years after anterior cruciate ligament reconstruction: a population cohort study.
abstract: BACKGROUND
  The predictors of anterior cruciate ligament reconstruction (ACLR) outcome at 6 years as measured by validated patient-based outcome instruments are unknown.
  
  
  OBJECTIVE
  Certain variables evaluated at the time of ACLR will predict return to sports function (as measured by the International Knee Documentation Committee [IKDC] questionnaire and the Knee injury and Osteoarthritis Outcome Score [KOOS] Sports and Recreation subscale), knee-related quality of life (KOOS Knee Related Quality of Life subscale), and activity level (Marx Activity Scale). Potential predictor variables include demographic factors, surgical technique and graft choice for ACLR, and intra-articular injuries and treatment.
  
  
  METHODS
  Cohort study; Level of evidence, 2.
  
  
  METHODS
  All patients with unilateral ACLRs from 2002 currently enrolled in the MOON (Multicenter Orthopaedic Outcomes Network) cohort were evaluated. Patients completed the validated outcome instruments preoperatively. Physicians documented intra-articular pathologic abnormalities, treatment, and surgical techniques used at the time of surgery. At 2 and 6 years postoperatively, patients completed the same validated outcome instruments.
  
  
  RESULTS
  Follow-up was obtained at 2 years (88%) and at 6 years (84%). The cohort was 57% male with a median age of 23 years at enrollment. The ability to perform sports function was maintained at 6 years, but the Marx activity level continued to decline from baseline. Revision ACLR and use of allograft predicted worse outcomes on the IKDC and both KOOS subscales. Lateral meniscus treatment, smoking status, and body mass index at baseline were each predictors on 2 of 3 scales. The predictors of lower activity level were revision ACLR and female sex.
  
  
  CONCLUSIONS
  Six years after ACLR, patients could perform sports-related functions and maintain a high knee-related quality of life similar to their 2-year level, although their physical activity level (Marx) dropped over time. Choosing autograft rather than allograft, not smoking, and having normal body mass index are advised to improve long-term outcomes.
authors.affiliation: Vanderbilt Sports Medicine, 4200 Medical Center East, South Tower, 1215 21st Ave South, Nashville, TN 37232-8774, USA. kurt.spindler@vanderbilt.edu
authors.forename: Kurt P
authors.initials: KP
authors.lastname: Spindler
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Huston
authors.forename: Rick W
authors.initials: RW
authors.lastname: Wright
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Kaeding
authors.forename: Robert G
authors.initials: RG
authors.lastname: Marx
authors.forename: Annunziato
authors.initials: A
authors.lastname: Amendola
authors.forename: Richard D
authors.initials: RD
authors.lastname: Parker
authors.forename: Jack T
authors.initials: JT
authors.lastname: Andrish
authors.forename: Emily K
authors.initials: EK
authors.lastname: Reinke
authors.forename: Frank E
authors.initials: FE
authors.lastname: Harrell
authors.forename: Warren R
authors.initials: WR
authors.lastname: Dunn
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery*; D056352:Athletes; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D011379:Prognosis; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D055815:Young Adult