A majority of the patient achieved both patient-acceptable symptom state and minimal clinically important difference of International Knee Documentation Committee Subjective Knee Form score at one year after anatomical double-bundle anterior cruciate ligament reconstruction

Abstract

Objectives

There is a paucity of data about clinical outcomes after double-bundle anterior cruciate ligament reconstruction (DB-ACLR) using the concepts of patient-acceptable symptom state (PASS) and minimal clinically important difference (MCID). The aim of the present study was to evaluate the one-year clinical outcomes of patients who underwent DB-ACLR using PASS and MCID.

Methods

Achievement of PASS and MCID were retrospectively evaluated for 298 (mean age 26.9 years; 145 men/153 women) and 214 patients (mean age 23.9 years; 114 males/100 females), respectively, who underwent primary DB-ACLR using a hamstring autograft. For patients who achieved PASS or MCID, demographics, preoperative and postoperative data were statistically analyzed.

Results

Of 298 patients, 254 (85.2%) achieved International Knee Documentation Committee-Subjective Knee Form (IKDC-SKF) PASS and 191 out of 214 patients (88.8%) achieved MCID. The dichotomous logistic regression analyses to assess the achievement of PASS showed that younger age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.93–0.99; P ​= ​0.013), male sex (OR, 2.2; 95% CI, 1.08–4.83; P ​= ​0.030) and better one-year quadriceps strength symmetry (OR, 1.05; 95% CI, 1.03–1.07; P ​< ​0.001) were independent predictors of PASS achievement. For MCID, preoperative IKDC-SKF score below the 50th percentile (OR, 14.39; 95% CI, 2.90–71.25; P ​= ​0.001) and better one-year quadriceps strength symmetry (OR, 1.035; 95% CI, 1.007–1.064; P ​= ​0.014) were independent predictors for MCID achievement.

Conclusions

More than 85% of the patients achieved PASS and MCID for the IKDC-SKF score one year after undergoing DB-ACLR with hamstring tendon autograft. Better quadriceps strength symmetry at one year contributed to the achievement of both PASS and MCID. Rehabilitation dedicated to quadriceps strength recovery may be important for achieving good clinical outcomes after DB-ACLR.

Level of evidence

IV, retrospective cohort.