Summary

This study found that patients that underwent arthroscopic primary ACL repair have significantly less knee joint awareness than reconstruction patients

Abstract

Introduction

Recently, there has been a resurgence of interest in arthroscopic primary repair of proximal anterior cruciate ligament (ACL) tears. Primary repair has the advantage of a less invasive and knee preservation surgery when compared to the current gold standard of ACL reconstruction and one can expect better patient experience following this procedure. To date, no studies have assessed the knee joint awareness following both procedures even though this is an important outcome following surgery. The goal of this study was therefore to assess the differences in knee joint awareness following arthroscopic primary repair versus reconstruction of the anterior cruciate ligament (ACL).

Methods

All patients that underwent operative treatment for ACL injury by one author between September 2011 and September 2016 were included. Arthroscopic primary ACL repair was performed for patients with proximal tears and otherwise standard ACL reconstruction was performed. All patients were contacted and asked to complete the Forgotten Joint Score (FJS) questionnaire in clinic or online. The FJS score has been validated to assess knee joint awareness following ACL surgery and assess how much a patient is bothered by their knee during daily life. The minimal detectable change (MDC) for this outcome is 14 points.

Results

57 patients responded and completed the questionnaire of which 37 underwent primary ACL repair and 20 ACL reconstruction. Mean age was 33 years (range 15 – 54 years), mean BMI 25 (range 18 – 35), 59% were male, and mean follow-up was 2.9 years (2 – 5 years). No difference in patient characteristics existed between both groups.

Patients following arthroscopic primary ACL repair had significantly less joint awareness when compared to patients following ACL reconstruction (88.8±10.9 vs 73.5±11.1, p=0.001), which exceeds the MDC. Eleven repair patients (30%) reported no awareness at all of their operated knee in daily life whereas one reconstruction patients (0%) had no awareness at all (p=0.05).

Conclusions

Patients following arthroscopic primary ACL repair have significantly less awareness of their operated knee and ACL at short- to mid-term follow-up when compared to ACL reconstruction. This can likely be explained by the minimal invasive and preservation surgery with primary repair. Patients should be counseled of these differences at short- to mid-term follow-up.