title: Limitations in predicting outcome following primary ACL reconstruction with single-bundle hamstring autograft - A systematic review.
abstract: BACKGROUND
  Anterior cruciate ligament reconstruction (ACLR) is one of the most well studied and performed procedures in the world. Thus, it would be useful to develop a tool to predict patient outcomes post-operatively to allow clinicians to optimise management.
  
  
  OBJECTIVE
  To identify and summarise factors predictive of graft failure and patient-reported outcome (PROM) measures at minimum two years after ACLR with single-bundle quadruple hamstring autograft via the anteromedial portal technique.
  
  
  METHODS
  Studies reporting IKDC, KOOS, Lysholm and graft failure in ACLR were systematically reviewed. A methodological score was applied to these studies, with those above the mean analysed further. Only those reporting primary predictors of patient outcomes following ACLR were included.
  
  
  RESULTS
  Twenty-six studies satisfied our inclusion criteria. Fourteen scored above the mean 20 Downs and Black score (18.4) and were considered higher level evidence. The higher quality papers reported that younger age, female sex, higher BMI, smoking history and activity levels predicted poorer outcomes. High-grade tears of the menisci or full-thickness cartilage defects were identified as predictors of poorer PROMs. None of the factors investigated by more than a single paper were unanimously significant in predicting the outcome of ACLR.
  
  
  CONCLUSIONS
  The evidence surrounding predictors of outcome was inconsistent in design, methodology and reporting of results, hindering our ability to draw conclusions regarding the validity of the reported relationships. However, this systematic review identified several patient demographics, concomitant injuries, and surgical factors that could be investigated further in future prospective studies to create a definitive predictive model.
authors.affiliation: Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia; Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia. Electronic address: VAn@sori.com.au.
authors.forename: Vincent Vg
authors.initials: VV
authors.lastname: An
authors.affiliation: Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia.
authors.forename: Corey
authors.initials: C
authors.lastname: Scholes
authors.affiliation: Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia.
authors.forename: Vikram A
authors.initials: VA
authors.lastname: Mhaskar
authors.affiliation: Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia; Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia.
authors.forename: William J
authors.initials: WJ
authors.lastname: Hadden
authors.affiliation: Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Parker
mesh_terms: D000070598:Anterior Cruciate Ligament Injuries / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D064592:Autografts; D000070632:Hamstring Tendons / Q000637:transplantation*; D006801:Humans; D000071066:Patient Reported Outcome Measures; D011379:Prognosis; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: Anterior cruciate ligament; Knee; Patient-reported outcome; Predictors; Systematic review