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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 1/2016

01-01-2016 | Knee

Patient expectations of primary and revision anterior cruciate ligament reconstruction

Authors: Matthias J. Feucht, Matthias Cotic, Tim Saier, Philipp Minzlaff, Johannes E. Plath, Andreas B. Imhoff, Stefan Hinterwimmer

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 1/2016

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Abstract

Purpose

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.

Level of evidence

Prospective case series, Level IV.
Literature
1.
go back to reference Ajuied A, Wong F, Smith C, Norris M, Earnshaw P, Back D, Davies A (2014) Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med 42(9):2242–2252PubMedCrossRef Ajuied A, Wong F, Smith C, Norris M, Earnshaw P, Back D, Davies A (2014) Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med 42(9):2242–2252PubMedCrossRef
2.
go back to reference Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 45(7):596–606PubMedCrossRef Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 45(7):596–606PubMedCrossRef
3.
go back to reference Brown CA, McAdams TR, Harris AH, Maffulli N, Safran MR (2013) ACL reconstruction in patients aged 40 years and older: a systematic review and introduction of a new methodology score for ACL studies. Am J Sports Med 41(9):2181–2190PubMedCrossRef Brown CA, McAdams TR, Harris AH, Maffulli N, Safran MR (2013) ACL reconstruction in patients aged 40 years and older: a systematic review and introduction of a new methodology score for ACL studies. Am J Sports Med 41(9):2181–2190PubMedCrossRef
4.
go back to reference Cailliez J, Reina N, Molinier F, Chaminade B, Chiron P, Laffosse JM (2012) Patient information ahead of anterior cruciate ligament reconstruction: experience in a university hospital center. Orthop Traumatol Surg Res 98(5):491–498PubMedCrossRef Cailliez J, Reina N, Molinier F, Chaminade B, Chiron P, Laffosse JM (2012) Patient information ahead of anterior cruciate ligament reconstruction: experience in a university hospital center. Orthop Traumatol Surg Res 98(5):491–498PubMedCrossRef
5.
go back to reference Cheng T, Zhang GY, Zhang XL (2012) Does computer navigation system really improve early clinical outcomes after anterior cruciate ligament reconstruction? A meta-analysis and systematic review of randomized controlled trials. Knee 19(2):73–77PubMedCrossRef Cheng T, Zhang GY, Zhang XL (2012) Does computer navigation system really improve early clinical outcomes after anterior cruciate ligament reconstruction? A meta-analysis and systematic review of randomized controlled trials. Knee 19(2):73–77PubMedCrossRef
7.
go back to reference Culliton SE, Bryant DM, Overend TJ, MacDonald SJ, Chesworth BM (2012) The relationship between expectations and satisfaction in patients undergoing primary total knee arthroplasty. J Arthroplasty 27(3):490–492PubMedCrossRef Culliton SE, Bryant DM, Overend TJ, MacDonald SJ, Chesworth BM (2012) The relationship between expectations and satisfaction in patients undergoing primary total knee arthroplasty. J Arthroplasty 27(3):490–492PubMedCrossRef
8.
go back to reference Gifstad T, Drogset JO, Viset A, Grontvedt T, Hortemo GS (2013) Inferior results after revision ACL reconstructions: a comparison with primary ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 21(9):2011–2018PubMedCrossRef Gifstad T, Drogset JO, Viset A, Grontvedt T, Hortemo GS (2013) Inferior results after revision ACL reconstructions: a comparison with primary ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 21(9):2011–2018PubMedCrossRef
9.
go back to reference Henn RF 3rd, Kang L, Tashjian RZ, Green A (2007) Patients’ preoperative expectations predict the outcome of rotator cuff repair. J Bone Joint Surg Am 89(9):1913–1919PubMedCrossRef Henn RF 3rd, Kang L, Tashjian RZ, Green A (2007) Patients’ preoperative expectations predict the outcome of rotator cuff repair. J Bone Joint Surg Am 89(9):1913–1919PubMedCrossRef
10.
go back to reference Hu J, Qu J, Xu D, Zhou J, Lu H (2013) Allograft versus autograft for anterior cruciate ligament reconstruction: an up-to-date meta-analysis of prospective studies. Int Orthop 37(2):311–320PubMedPubMedCentralCrossRef Hu J, Qu J, Xu D, Zhou J, Lu H (2013) Allograft versus autograft for anterior cruciate ligament reconstruction: an up-to-date meta-analysis of prospective studies. Int Orthop 37(2):311–320PubMedPubMedCentralCrossRef
11.
go back to reference Iles RA, Davidson M, Taylor NF, O’Halloran P (2009) Systematic review of the ability of recovery expectations to predict outcomes in non-chronic non-specific low back pain. J Occup Rehabil 19(1):25–40PubMedCrossRef Iles RA, Davidson M, Taylor NF, O’Halloran P (2009) Systematic review of the ability of recovery expectations to predict outcomes in non-chronic non-specific low back pain. J Occup Rehabil 19(1):25–40PubMedCrossRef
12.
go back to reference Iversen MD, Daltroy LH, Fossel AH, Katz JN (1998) The prognostic importance of patient pre-operative expectations of surgery for lumbar spinal stenosis. Patient Educ Couns 34(2):169–178PubMedCrossRef Iversen MD, Daltroy LH, Fossel AH, Katz JN (1998) The prognostic importance of patient pre-operative expectations of surgery for lumbar spinal stenosis. Patient Educ Couns 34(2):169–178PubMedCrossRef
13.
go back to reference Kievit AJ, Jonkers FJ, Barentsz JH, Blankevoort L (2013) A cross-sectional study comparing the rates of osteoarthritis, laxity, and quality of life in primary and revision anterior cruciate ligament reconstructions. Arthroscopy 29(5):898–905PubMedCrossRef Kievit AJ, Jonkers FJ, Barentsz JH, Blankevoort L (2013) A cross-sectional study comparing the rates of osteoarthritis, laxity, and quality of life in primary and revision anterior cruciate ligament reconstructions. Arthroscopy 29(5):898–905PubMedCrossRef
14.
go back to reference Kocher MS, Steadman JR, Briggs K, Zurakowski D, Sterett WI, Hawkins RJ (2002) Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Joint Surg Am 84(9):1560–1572PubMed Kocher MS, Steadman JR, Briggs K, Zurakowski D, Sterett WI, Hawkins RJ (2002) Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Joint Surg Am 84(9):1560–1572PubMed
15.
go back to reference Kraeutler MJ, Bravman JT, McCarty EC (2013) Bone–patellar tendon–bone autograft versus allograft in outcomes of anterior cruciate ligament reconstruction: a meta-analysis of 5182 patients. Am J Sports Med 41(10):2439–2448PubMedCrossRef Kraeutler MJ, Bravman JT, McCarty EC (2013) Bone–patellar tendon–bone autograft versus allograft in outcomes of anterior cruciate ligament reconstruction: a meta-analysis of 5182 patients. Am J Sports Med 41(10):2439–2448PubMedCrossRef
16.
go back to reference Kvist J (2004) Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation. Sports Med 34(4):269–280PubMedCrossRef Kvist J (2004) Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation. Sports Med 34(4):269–280PubMedCrossRef
17.
go back to reference Lamblin CJ, Waterman BR, Lubowitz JH (2013) Anterior cruciate ligament reconstruction with autografts compared with non-irradiated, non-chemically treated allografts. Arthroscopy 29(6):1113–1122PubMedCrossRef Lamblin CJ, Waterman BR, Lubowitz JH (2013) Anterior cruciate ligament reconstruction with autografts compared with non-irradiated, non-chemically treated allografts. Arthroscopy 29(6):1113–1122PubMedCrossRef
18.
go back to reference Lavoie P, Fletcher J, Duval N (2001) Correlation between patients’ satisfaction and objective measurement of knee stability after ACL reconstruction using a patellar tendon autograft. Knee 8(1):19–24PubMedCrossRef Lavoie P, Fletcher J, Duval N (2001) Correlation between patients’ satisfaction and objective measurement of knee stability after ACL reconstruction using a patellar tendon autograft. Knee 8(1):19–24PubMedCrossRef
19.
go back to reference Li S, Chen Y, Lin Z, Cui W, Zhao J, Su W (2012) A systematic review of randomized controlled clinical trials comparing hamstring autografts versus bone–patellar tendon–bone autografts for the reconstruction of the anterior cruciate ligament. Arch Orthop Trauma Surg 132(9):1287–1297PubMedCrossRef Li S, Chen Y, Lin Z, Cui W, Zhao J, Su W (2012) A systematic review of randomized controlled clinical trials comparing hamstring autografts versus bone–patellar tendon–bone autografts for the reconstruction of the anterior cruciate ligament. Arch Orthop Trauma Surg 132(9):1287–1297PubMedCrossRef
20.
go back to reference Li S, Su W, Zhao J, Xu Y, Bo Z, Ding X, Wei Q (2011) A meta-analysis of hamstring autografts versus bone–patellar tendon–bone autografts for reconstruction of the anterior cruciate ligament. Knee 18(5):287–293PubMedCrossRef Li S, Su W, Zhao J, Xu Y, Bo Z, Ding X, Wei Q (2011) A meta-analysis of hamstring autografts versus bone–patellar tendon–bone autografts for reconstruction of the anterior cruciate ligament. Knee 18(5):287–293PubMedCrossRef
21.
go back to reference Li X, Xu CP, Song JQ, Jiang N, Yu B (2013) Single-bundle versus double-bundle anterior cruciate ligament reconstruction: an up-to-date meta-analysis. Int Orthop 37(2):213–226PubMedPubMedCentralCrossRef Li X, Xu CP, Song JQ, Jiang N, Yu B (2013) Single-bundle versus double-bundle anterior cruciate ligament reconstruction: an up-to-date meta-analysis. Int Orthop 37(2):213–226PubMedPubMedCentralCrossRef
22.
go back to reference Lieberman JR, Dorey F, Shekelle P, Schumacher L, Thomas BJ, Kilgus DJ, Finerman GA (1996) Differences between patients’ and physicians’ evaluations of outcome after total hip arthroplasty. J Bone Joint Surg Am 78(6):835–838PubMed Lieberman JR, Dorey F, Shekelle P, Schumacher L, Thomas BJ, Kilgus DJ, Finerman GA (1996) Differences between patients’ and physicians’ evaluations of outcome after total hip arthroplasty. J Bone Joint Surg Am 78(6):835–838PubMed
23.
go back to reference Lind M, Menhert F, Pedersen AB (2012) Incidence and outcome after revision anterior cruciate ligament reconstruction: results from the Danish registry for knee ligament reconstructions. Am J Sports Med 40(7):1551–1557PubMedCrossRef Lind M, Menhert F, Pedersen AB (2012) Incidence and outcome after revision anterior cruciate ligament reconstruction: results from the Danish registry for knee ligament reconstructions. Am J Sports Med 40(7):1551–1557PubMedCrossRef
24.
go back to reference Lurie JD, Weinstein JN (2001) Shared decision-making and the orthopaedic workforce. Clin Orthop Relat Res 385:68–75PubMedCrossRef Lurie JD, Weinstein JN (2001) Shared decision-making and the orthopaedic workforce. Clin Orthop Relat Res 385:68–75PubMedCrossRef
25.
go back to reference Magnussen RA, Carey JL, Spindler KP (2011) Does autograft choice determine intermediate-term outcome of ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 19(3):462–472PubMedPubMedCentralCrossRef Magnussen RA, Carey JL, Spindler KP (2011) Does autograft choice determine intermediate-term outcome of ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 19(3):462–472PubMedPubMedCentralCrossRef
26.
go back to reference Mahomed NN, Liang MH, Cook EF, Daltroy LH, Fortin PR, Fossel AH, Katz JN (2002) The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol 29(6):1273–1279PubMed Mahomed NN, Liang MH, Cook EF, Daltroy LH, Fortin PR, Fossel AH, Katz JN (2002) The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol 29(6):1273–1279PubMed
27.
go back to reference Mancuso CA, Graziano S, Briskie LM, Peterson MG, Pellicci PM, Salvati EA, Sculco TP (2008) Randomized trials to modify patients’ preoperative expectations of hip and knee arthroplasties. Clin Orthop Relat Res 466(2):424–431PubMedPubMedCentralCrossRef Mancuso CA, Graziano S, Briskie LM, Peterson MG, Pellicci PM, Salvati EA, Sculco TP (2008) Randomized trials to modify patients’ preoperative expectations of hip and knee arthroplasties. Clin Orthop Relat Res 466(2):424–431PubMedPubMedCentralCrossRef
28.
go back to reference Mariscalco MW, Magnussen RA, Mehta D, Hewett TE, Flanigan DC, Kaeding CC (2013) Autograft versus nonirradiated allograft tissue for anterior cruciate ligament reconstruction: a systematic review. Am J Sports Med 29(12):1948–1953 Mariscalco MW, Magnussen RA, Mehta D, Hewett TE, Flanigan DC, Kaeding CC (2013) Autograft versus nonirradiated allograft tissue for anterior cruciate ligament reconstruction: a systematic review. Am J Sports Med 29(12):1948–1953
29.
go back to reference Mohtadi NG, Chan DS, Dainty KN, Whelan DB (2011) Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev 9:CD005960PubMed Mohtadi NG, Chan DS, Dainty KN, Whelan DB (2011) Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev 9:CD005960PubMed
30.
go back to reference Mulford JS, Hutchinson SE, Hang JR (2013) Outcomes for primary anterior cruciate reconstruction with the quadriceps autograft: a systematic review. Knee Surg Sports Traumatol Arthrosc 21(8):1882–1888PubMedCrossRef Mulford JS, Hutchinson SE, Hang JR (2013) Outcomes for primary anterior cruciate reconstruction with the quadriceps autograft: a systematic review. Knee Surg Sports Traumatol Arthrosc 21(8):1882–1888PubMedCrossRef
31.
go back to reference Muneta T, Hara K, Ju YJ, Mochizuki T, Morito T, Yagishita K, Sekiya I (2010) Revision anterior cruciate ligament reconstruction by double-bundle technique using multi-strand semitendinosus tendon. Arthroscopy 26(6):769–781PubMedCrossRef Muneta T, Hara K, Ju YJ, Mochizuki T, Morito T, Yagishita K, Sekiya I (2010) Revision anterior cruciate ligament reconstruction by double-bundle technique using multi-strand semitendinosus tendon. Arthroscopy 26(6):769–781PubMedCrossRef
32.
go back to reference Niemeyer P, Porichis S, Salzmann G, Südkamp NP (2012) What patients expect about autologues chondrocyte implantation for treatment of cartilage defects at the knee joint. Cartilage 3(1):13–19PubMedPubMedCentralCrossRef Niemeyer P, Porichis S, Salzmann G, Südkamp NP (2012) What patients expect about autologues chondrocyte implantation for treatment of cartilage defects at the knee joint. Cartilage 3(1):13–19PubMedPubMedCentralCrossRef
33.
go back to reference Noble PC, Conditt MA, Cook KF, Mathis KB (2006) The John Insall award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 452:35–43PubMedCrossRef Noble PC, Conditt MA, Cook KF, Mathis KB (2006) The John Insall award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 452:35–43PubMedCrossRef
34.
go back to reference Novak EJ, Vail TP, Bozic KJ (2008) Advances in orthopaedic outcomes research. J Surg Orthop Adv 17(3):200–203PubMed Novak EJ, Vail TP, Bozic KJ (2008) Advances in orthopaedic outcomes research. J Surg Orthop Adv 17(3):200–203PubMed
35.
go back to reference Rosenberger PH, Jokl P, Cameron A, Ickovics JR (2005) Shared decision making, preoperative expectations, and postoperative reality: differences in physician and patient predictions and ratings of knee surgery outcomes. Arthroscopy 21(5):562–569PubMedCrossRef Rosenberger PH, Jokl P, Cameron A, Ickovics JR (2005) Shared decision making, preoperative expectations, and postoperative reality: differences in physician and patient predictions and ratings of knee surgery outcomes. Arthroscopy 21(5):562–569PubMedCrossRef
36.
go back to reference Scott CE, Howie CR, MacDonald D, Biant LC (2010) Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 92(9):1253–1258PubMedCrossRef Scott CE, Howie CR, MacDonald D, Biant LC (2010) Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 92(9):1253–1258PubMedCrossRef
37.
go back to reference Shen C, Jiang SD, Jiang LS, Dai LY (2010) Bioabsorbable versus metallic interference screw fixation in anterior cruciate ligament reconstruction: a meta-analysis of randomized controlled trials. Arthroscopy 26(5):705–713PubMedCrossRef Shen C, Jiang SD, Jiang LS, Dai LY (2010) Bioabsorbable versus metallic interference screw fixation in anterior cruciate ligament reconstruction: a meta-analysis of randomized controlled trials. Arthroscopy 26(5):705–713PubMedCrossRef
38.
go back to reference Tiamklang T, Sumanont S, Foocharoen T, Laopaiboon M (2012) Double-bundle versus single-bundle reconstruction for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev 11:8413 Tiamklang T, Sumanont S, Foocharoen T, Laopaiboon M (2012) Double-bundle versus single-bundle reconstruction for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev 11:8413
39.
go back to reference Warth RJ, Briggs KK, Dornan GJ, Horan MP, Millett PJ (2013) Patient expectations before arthroscopic shoulder surgery: correlation with patients’ reasons for seeking treatment. J Shoulder Elb Surg 22(12):1676–1681CrossRef Warth RJ, Briggs KK, Dornan GJ, Horan MP, Millett PJ (2013) Patient expectations before arthroscopic shoulder surgery: correlation with patients’ reasons for seeking treatment. J Shoulder Elb Surg 22(12):1676–1681CrossRef
40.
go back to reference Wright RW, Gill CS, Chen L, Brophy RH, Matava MJ, Smith MV, Mall NA (2012) Outcome of revision anterior cruciate ligament reconstruction: a systematic review. J Bone Joint Surg Am 94(6):531–536PubMedPubMedCentralCrossRef Wright RW, Gill CS, Chen L, Brophy RH, Matava MJ, Smith MV, Mall NA (2012) Outcome of revision anterior cruciate ligament reconstruction: a systematic review. J Bone Joint Surg Am 94(6):531–536PubMedPubMedCentralCrossRef
41.
go back to reference Zhu Y, Tang RK, Zhao P, Zhu SS, Li YG, Li JB (2013) Double-bundle reconstruction results in superior clinical outcome than single-bundle reconstruction. Knee Surg Sports Traumatol Arthrosc 21(5):1085–1096PubMedCrossRef Zhu Y, Tang RK, Zhao P, Zhu SS, Li YG, Li JB (2013) Double-bundle reconstruction results in superior clinical outcome than single-bundle reconstruction. Knee Surg Sports Traumatol Arthrosc 21(5):1085–1096PubMedCrossRef
42.
go back to reference Zywiel MG, Mahomed A, Gandhi R, Perruccio AV, Mahomed NN (2013) Measuring expectations in orthopaedic surgery: a systematic review. Clin Orthop Relat Res 471(11):3446–3456PubMedPubMedCentralCrossRef Zywiel MG, Mahomed A, Gandhi R, Perruccio AV, Mahomed NN (2013) Measuring expectations in orthopaedic surgery: a systematic review. Clin Orthop Relat Res 471(11):3446–3456PubMedPubMedCentralCrossRef
Metadata
Title
Patient expectations of primary and revision anterior cruciate ligament reconstruction
Authors
Matthias J. Feucht
Matthias Cotic
Tim Saier
Philipp Minzlaff
Johannes E. Plath
Andreas B. Imhoff
Stefan Hinterwimmer
Publication date
01-01-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 1/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-014-3364-z

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