Abstract
Objectives:
Multiligament knee injuries (MLKIs) can be devastating to an athlete’s career but can also negatively affect participation in recreational activities and daily tasks. A subset of athletes at significant risk of MLKIs are American football players. MLKIs with an associated anterior cruciate ligament tear (ACL-MLKI) are almost always surgically treated to restore stability to the athlete’s knee and to preserve knee-related function and joint health later in life. However, currently, there is a paucity of mid- and long-term outcomes data related to MLKIs and their surgical management. The objective of this study was to investigate >2-year outcomes in American football players who had reconstruction of the anterior cruciate ligament (ACL) alongside any combination of additional knee ligament tears treated with repair or reconstructive surgery, constituting an ACL-MLKI, at a single institution. We hypothesized that greater than half of American football players who underwent surgical management for an ACL- MLKI would meet the International Knee Documentation Committee subjective knee form Patient Acceptable Symptomatic State (IKDC-PASS) cutoff, would be able to return to their pre-injury level of sport, and would be satisfied with their surgical treatment outcome.
Methods:
We utilized a single institution’s prospectively collected data repository to retrospectively- identify patients from 2001-2019 who were American football players, underwent surgical management for an ACL-MLKI, and were at least 2 years post-operative. We included patients with ACL reconstruction plus any additional combination of repair or reconstruction of the posterior cruciate ligament, medial or lateral collateral ligaments, or posterolateral corner. We excluded those with advanced osteoarthritis at the time of injury or morbid obesity. Follow-up for assessing patient-reported outcomes was performed using a web-based platform or via phone calls using 3 questionnaires: the IKDC, an institutionally developed surgical satisfaction questionnaire, and an institutionally-developed return-to-sport questionnaire. We calculated the proportions of patients meeting a previously published IKDC-PASS cutoff specific to isolated ACL reconstruction (IKDC³75.9) and calculated summary statistics for all outcomes data. As secondary analyses, we compared IKDC scores between 2-ligament and >2-ligament groups using independent t-tests and evaluated the association between age at surgery and IKDC scores using linear regression (alpha<0.05).
Results:
Outcomes data were successfully collected for 50 of 72 eligible patients (69%; mean follow-up time=7.9±4.0 years; Table 2). Of the 72 eligible patients, 55 (76%) had 2 ligaments surgically-treated, 16 (22%) had 3 ligaments surgically-treated, and 1 (2%) had 4 ligaments surgically-treated (Table 1). Among those with outcomes data (n=50), the mean IKDC score was 83.7, with 78% meeting the IKDC-PASS cutoff (Table 2). Only 7 patients (14%) did not return to sports participation due to limitations from their ACL-MLKI surgery, and 94% were either satisfied or very satisfied with their surgical outcome (Table 2). The 2-ligament and >2-ligament groups did not differ in IKDC scores at follow-up (2-ligament: 84.0±15.4; >2-ligament: 82.9±16.5; p=0.83). Age at surgery was not associated with IKDC score at follow-up (p=0.64).
Conclusions:
This study represents the largest cohort of American football players evaluated for mid- to long-term outcomes following ACL-MLKI surgery at a single institution. A high proportion of these athletes met the IKDC-PASS, successfully returned to sport, and were satisfied with their ACL-MLKI surgical treatment.
