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cohort to increase by 11% for every 1 point
increase in the Marx activity score [2].
Increased Pre-Reconstruction
Knee Laxity
Another recent MOON cohort study utilized a
group of 2333 patients who underwent primary
isolatedACL reconstruction without collateral or
posterior cruciate ligament injury to assess the
impact of high-grade pre-reconstruction knee
laxity on risk of subsequent revision ACL
reconstruction at 2 years follow-up [3]. Patients
with a Lachman or anterior drawer examination
greater than 10mm different from the
contralateral side, or a 3+ pivot-shift were
classified as having a high-grade laxity. High-
grade pre-operative laxity was noted in
743 patients (31.9%). The presence of high-
grade pre-reconstruction laxity was associated
with significantly increased odds of ACL graft
revision (OR=1.87, 95%CI: 1.19-2.95,
p
=0.007),
controlling for patient age, sex, Marx activity
level, level of competition, and graft type.
Other Potential Predictors
In the analysis of 2683ACL reconstructions with
6-year follow-up, numerous other factors were
evaluated as potential predictors of graft failure
risk [2]. The risk of revision ACL reconstruction
was not significantly associated with patient sex,
smoking status, sport, or meniscus status.
PATIENT FACTORS
AFFECTING PATIENT-
REPORTED OUTCOMES
Knee injury and Osteoarthritis
Outcome Score (KOOS) and
International Knee Documentation
Committee (IKDC) Scores
The MOON group reported 6 year outcomes
on 378 (84%) of 448 unilateral ACL
reconstructions [5]. The specifically reported
factors that predicted IKDC score and two
KOOS subscales: Knee-related quality of life
and sport/recreation function. Pre-operative
scores and prior ipsilateral ACL surgery (that
is to say that patient was undergoing a revision
ACL reconstruction) were noted to be strong
predictors of all three scores at 6 year follow-
up was the (All
p
<0.01). BMI at the time of
surgery was a significant predictor of the
IKDC and KOOS sports/rec at 6 years of
follow-up, with increased BMI associated with
decreased scores. Smoking at the time of
reconstruction was predictive of poorer IKDC
at 6 years follow-up. Increased ago was
associated with slightly higher IKDC scores at
6 years follow-up. Patient ethnicity, sex, and
marital status had no impact on patient-
reported outcomes.
High-grade pre-reconstruction laxity as
described above was not noted to be a predictor
of patient-reported outcomes 2 years following
ACL reconstruction [3].
The presence of a lateral meniscus tear that was
treated with observation was also associated
with better scores at 6 years follow-up on all
three scales. No effect of medial meniscus
status, articular cartilage status, or collateral
ligament status at reconstruction was noted in
any of the scores.
Marx Activity Score
In the previously reported publication of 6 year
outcomes on 378 (84%) of 448 unilateral ACL
reconstructions [5]. Marx activity score prior to
injury was the strongest predictor of Marx
activity level 6 years post-operative. Marx
activity level was also lower at follow-up in
females and those whose index surgery in the
study was a revision ACL reconstruction.
Patient ethnicity, age, and marital status had no
impact on patient-reported outcomes. Patients
who underwent a lateral meniscus repair were
noted to have lower activity level 6 years post-
operative, while medial meniscus, collateral
ligament, and articular cartilage status did not
significantly affect activity level 6 years post-
operative.