title: Patient expectations of primary and revision anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  Unrealistic patient expectations have been shown to negatively influence patient-reported outcomes in orthopaedic surgery. Knowledge about patient expectations is important to associate preoperative expectations with the reasonable outcome of a specific procedure. The purpose of this study was to prospectively analyse and to compare patient expectations of primary and revision anterior cruciate ligament reconstruction (ACLR) and to assess the factors associated with patient expectations.
  
  
  METHODS
  Preoperative expectations of 181 consecutive patients undergoing ACLR were assessed prospectively using a 5-item questionnaire. Primary ACLR (P-ACLR) was performed in 133 patients (73%), whereas 48 patients (27%) underwent revision ACLR (R-ACLR). The questionnaire assessed the expectation of the overall condition of the knee joint, return to sports, instability, pain, and risk of osteoarthritis.
  
  
  RESULTS
  All patients expected a normal (38%) or nearly normal (62%) condition of the knee joint. Return to sports at the same level was expected by 91%. With regard to instability (pain), no instability (pain) independent of the activity level was expected by 77% (58%). No or only a slightly increased risk of the development of osteoarthritis was expected by 98%. The R-ACLR group showed a significantly lower expectation of the overall condition (p = 0.001), return to sports (p < 0.001), and pain (p = 0.002). No statistically significant difference was found between female and male patients (n.s.). In the P-ACLR group, patients with a history of previous knee surgery showed inferior expectations of return to sports (p = 0.015) and risk of osteoarthritis (p = 0.011). Age, number of previous knee surgeries, and pre-injury sports level significantly influenced patient expectations.
  
  
  CONCLUSIONS
  Overall, patient expectations of ACL reconstruction are high. Patients undergoing revision ACL reconstruction have lower but still demanding expectations. Younger patients, patients without a history of knee surgery, and highly active patients have higher expectations. Explicit patient information about realistic goals of ACL reconstruction seems to be necessary in order to prevent postoperative dissatisfaction despite a successful operation in the surgeons' point of view.
  
  
  METHODS
  Prospective case series, Level IV.
authors.affiliation: Department for Orthopedic Sports Medicine, Technical University Munich, 81675, Munich, Germany. matthias.feucht@gmx.net.|Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Straße 55, 79106, Freiburg, Germany. matthias.feucht@gmx.net.
authors.forename: Matthias J
authors.initials: MJ
authors.lastname: Feucht
authors.affiliation: Department for Orthopedic Sports Medicine, Technical University Munich, 81675, Munich, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Cotic
authors.affiliation: Department for Orthopedic Sports Medicine, Technical University Munich, 81675, Munich, Germany.|Department of Trauma and Orthopaedic Surgery, Trauma Center Murnau, Murnau, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Saier
authors.affiliation: Department for Orthopedic Sports Medicine, Technical University Munich, 81675, Munich, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Minzlaff
authors.affiliation: Department for Orthopedic Sports Medicine, Technical University Munich, 81675, Munich, Germany.|Department of Trauma, Hand and Reconstructive Surgery, Zentralklinikum Augsburg, 86156, Augsburg, Germany.
authors.forename: Johannes E
authors.initials: JE
authors.lastname: Plath
authors.affiliation: Department for Orthopedic Sports Medicine, Technical University Munich, 81675, Munich, Germany.
authors.forename: Andreas B
authors.initials: AB
authors.lastname: Imhoff
authors.affiliation: Department for Orthopedic Sports Medicine, Technical University Munich, 81675, Munich, Germany.|Sportsclinic Germany, 81737, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hinterwimmer
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods / Q000523:psychology*; D001265:Athletic Injuries / Q000523:psychology* / Q000601:surgery; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000523:psychology* / Q000601:surgery; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D011446:Prospective Studies; D020127:Recovery of Function; D012086:Reoperation / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Anterior cruciate ligament; Knee; Patient expectations