Early Surgical Intervention Results in Better Patient-Reported Outcomes Than Delayed Treatment in Patients Undergoing Anterior Cruciate Ligament Reconstruction in the Presence of Concomitant Medial Collateral Ligament Injury
Purpose: To investigate the influence of the timing of anterior cruciate ligament (ACL) reconstruction (ACLR) on patient-reported outcomes, comparing patients with and without concomitant medial collateral ligament (MCL) injury. Methods: This study included patients who underwent ACLR between Septem...
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Elsevier
2025-04-01
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| Series: | Arthroscopy, Sports Medicine, and Rehabilitation |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666061X24001810 |
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| author | Blake M. Bacevich, B.S. Sean Hazzard, P.A., M.B.A. Mia Lustig, B.S. Saoirse Connelly, B.S. Varun Nukala, B.S. Peter Asnis, M.D. |
| author_facet | Blake M. Bacevich, B.S. Sean Hazzard, P.A., M.B.A. Mia Lustig, B.S. Saoirse Connelly, B.S. Varun Nukala, B.S. Peter Asnis, M.D. |
| author_sort | Blake M. Bacevich, B.S. |
| collection | DOAJ |
| description | Purpose: To investigate the influence of the timing of anterior cruciate ligament (ACL) reconstruction (ACLR) on patient-reported outcomes, comparing patients with and without concomitant medial collateral ligament (MCL) injury. Methods: This study included patients who underwent ACLR between September 2015 and October 2020. The inclusion criteria included patients for whom preoperative and postoperative patient-reported outcome measures were available and a follow-up period of at least 2 years. Patients who sustained grade 2 or 3 MCL injuries with ACL tears were compared with patients with no MCL injuries as a control. All patients underwent ACLR with either bone-tendon-bone autograft or bone-tendon-bone allograft. Patient-reported outcomes (International Knee Documentation Committee [IKDC] score, Lysholm score, and Knee Injury and Osteoarthritis Outcome Score [KOOS]) were recorded, and outcomes were analyzed by sex and time from index injury. A stratified linear mixed-effects regression analysis was conducted. Results: A total of 253 eligible patients with 2-year outcomes were enrolled. Patients with combined ACL-MCL injuries had lower IKDC scores (β = –6.1 vs β = –8.3, P = .003), KOOS Quality of Life values (β = –9.3 vs β = –11, P = .004), and KOOS Sport values (β = –12 vs β = –13, P = .08) if surgery was performed more than 6 weeks after the index injury. Patients with isolated ACL injuries showed lower KOOS Activities of Daily Living values (β = –2.4, P = .045) if surgery was performed at between 3 and 6 months. Among patients with combined ACL-MCL injuries, autograft was found to have worse IKDC scores (β = –11 [95% confidence interval (CI), –18 to –4.2]; P = .002), Lysholm scores (β = –9.2 [95% CI, –15 to –3.1]; P = .004), KOOS Quality of Life values (β = –11 [95% CI, –20 to –1.6]; P = .023), KOOS Pain values (β = –5.1 [95% CI, –10 to –0.03]; P = .049), KOOS Symptoms values (β = –7.6 [95% CI, –10 to –0.03]; P = .02), and KOOS Sport values (β = –21 [95% CI, –32 to –10]; P < .001) than allograft. Conclusions: Patients undergoing ACLR with grade 2 or 3 MCL injuries have improved patient-reported outcomes if surgery is performed within 6 weeks from the time of injury. In this cohort, allografts resulted in better outcome scores compared with autografts. Level of Evidence: Level III, retrospective cohort study. |
| format | Article |
| id | doaj-art-4287a9bd6d244c8d8985f22d8aa105ae |
| institution | OA Journals |
| issn | 2666-061X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
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| series | Arthroscopy, Sports Medicine, and Rehabilitation |
| spelling | doaj-art-4287a9bd6d244c8d8985f22d8aa105ae2025-08-20T02:17:28ZengElsevierArthroscopy, Sports Medicine, and Rehabilitation2666-061X2025-04-017210103810.1016/j.asmr.2024.101038Early Surgical Intervention Results in Better Patient-Reported Outcomes Than Delayed Treatment in Patients Undergoing Anterior Cruciate Ligament Reconstruction in the Presence of Concomitant Medial Collateral Ligament InjuryBlake M. Bacevich, B.S.0Sean Hazzard, P.A., M.B.A.1Mia Lustig, B.S.2Saoirse Connelly, B.S.3Varun Nukala, B.S.4Peter Asnis, M.D.5Harvard Medical School, Boston, Massachusetts, U.S.A.Department of Orthopaedics/Sports Medicine Service, Massachusetts General Hospital, Waltham, Massachusetts, U.S.A.; Address correspondence to Sean Hazzard, P.A., M.B.A., Department of Orthopaedics/Sports Medicine Service, Massachusetts General Hospital, 52 Second Ave, Blue Bldg Third Floor, Waltham, MA 02451, U.S.A.Department of Orthopaedics/Sports Medicine Service, Massachusetts General Hospital, Waltham, Massachusetts, U.S.A.Department of Orthopaedics/Sports Medicine Service, Massachusetts General Hospital, Waltham, Massachusetts, U.S.A.Department of Orthopaedics/Sports Medicine Service, Massachusetts General Hospital, Waltham, Massachusetts, U.S.A.Department of Orthopaedics/Sports Medicine Service, Massachusetts General Hospital, Waltham, Massachusetts, U.S.A.Purpose: To investigate the influence of the timing of anterior cruciate ligament (ACL) reconstruction (ACLR) on patient-reported outcomes, comparing patients with and without concomitant medial collateral ligament (MCL) injury. Methods: This study included patients who underwent ACLR between September 2015 and October 2020. The inclusion criteria included patients for whom preoperative and postoperative patient-reported outcome measures were available and a follow-up period of at least 2 years. Patients who sustained grade 2 or 3 MCL injuries with ACL tears were compared with patients with no MCL injuries as a control. All patients underwent ACLR with either bone-tendon-bone autograft or bone-tendon-bone allograft. Patient-reported outcomes (International Knee Documentation Committee [IKDC] score, Lysholm score, and Knee Injury and Osteoarthritis Outcome Score [KOOS]) were recorded, and outcomes were analyzed by sex and time from index injury. A stratified linear mixed-effects regression analysis was conducted. Results: A total of 253 eligible patients with 2-year outcomes were enrolled. Patients with combined ACL-MCL injuries had lower IKDC scores (β = –6.1 vs β = –8.3, P = .003), KOOS Quality of Life values (β = –9.3 vs β = –11, P = .004), and KOOS Sport values (β = –12 vs β = –13, P = .08) if surgery was performed more than 6 weeks after the index injury. Patients with isolated ACL injuries showed lower KOOS Activities of Daily Living values (β = –2.4, P = .045) if surgery was performed at between 3 and 6 months. Among patients with combined ACL-MCL injuries, autograft was found to have worse IKDC scores (β = –11 [95% confidence interval (CI), –18 to –4.2]; P = .002), Lysholm scores (β = –9.2 [95% CI, –15 to –3.1]; P = .004), KOOS Quality of Life values (β = –11 [95% CI, –20 to –1.6]; P = .023), KOOS Pain values (β = –5.1 [95% CI, –10 to –0.03]; P = .049), KOOS Symptoms values (β = –7.6 [95% CI, –10 to –0.03]; P = .02), and KOOS Sport values (β = –21 [95% CI, –32 to –10]; P < .001) than allograft. Conclusions: Patients undergoing ACLR with grade 2 or 3 MCL injuries have improved patient-reported outcomes if surgery is performed within 6 weeks from the time of injury. In this cohort, allografts resulted in better outcome scores compared with autografts. Level of Evidence: Level III, retrospective cohort study.http://www.sciencedirect.com/science/article/pii/S2666061X24001810 |
| spellingShingle | Blake M. Bacevich, B.S. Sean Hazzard, P.A., M.B.A. Mia Lustig, B.S. Saoirse Connelly, B.S. Varun Nukala, B.S. Peter Asnis, M.D. Early Surgical Intervention Results in Better Patient-Reported Outcomes Than Delayed Treatment in Patients Undergoing Anterior Cruciate Ligament Reconstruction in the Presence of Concomitant Medial Collateral Ligament Injury Arthroscopy, Sports Medicine, and Rehabilitation |
| title | Early Surgical Intervention Results in Better Patient-Reported Outcomes Than Delayed Treatment in Patients Undergoing Anterior Cruciate Ligament Reconstruction in the Presence of Concomitant Medial Collateral Ligament Injury |
| title_full | Early Surgical Intervention Results in Better Patient-Reported Outcomes Than Delayed Treatment in Patients Undergoing Anterior Cruciate Ligament Reconstruction in the Presence of Concomitant Medial Collateral Ligament Injury |
| title_fullStr | Early Surgical Intervention Results in Better Patient-Reported Outcomes Than Delayed Treatment in Patients Undergoing Anterior Cruciate Ligament Reconstruction in the Presence of Concomitant Medial Collateral Ligament Injury |
| title_full_unstemmed | Early Surgical Intervention Results in Better Patient-Reported Outcomes Than Delayed Treatment in Patients Undergoing Anterior Cruciate Ligament Reconstruction in the Presence of Concomitant Medial Collateral Ligament Injury |
| title_short | Early Surgical Intervention Results in Better Patient-Reported Outcomes Than Delayed Treatment in Patients Undergoing Anterior Cruciate Ligament Reconstruction in the Presence of Concomitant Medial Collateral Ligament Injury |
| title_sort | early surgical intervention results in better patient reported outcomes than delayed treatment in patients undergoing anterior cruciate ligament reconstruction in the presence of concomitant medial collateral ligament injury |
| url | http://www.sciencedirect.com/science/article/pii/S2666061X24001810 |
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