Analysis of the Swedish Knee Ligament Register: Concomitant injuries, revision surgery and smoking render worse results

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Abstract
Purpose: To analyse the 52,199 patients in the Swedish Knee Ligament Register (SKLR) preoperatively, and the patients reaching 5‐ and 10‐year follow‐ups who underwent anterior cruciate ligament reconstruction (ACLR), revision ACLR and ACLR on the contralateral side (CACLR). The main hypothesis was that patients undergoing revision ACLR would have worse patient‐reported outcome measurements (PROMs) than the primary ACLR group at 10 years and that smoking and concomitant injuries would result in poorer outcomes for all groups. Methods: Data from 2005 to 2021 were extracted from the SKLR. Only patients whose ACLR surgery was registered in the SKLR were included for revision ACLR and CACLR. The PROMs consist of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the knee‐specific PROM (EQ‐5D‐3L). PROMs were analysed as a whole and in subgroups based on sex, smoking, graft choice and concomitant injuries. Results: Poorer KOOS were seen for revisions compared with primary ACLRs at both the 5‐ and 10‐year follow‐ups ( p = 0.003). Smokers had significantly poorer KOOS than nonsmokers ( p < 0.001) preoperatively in all groups, however only in the primary ACLR group at 5 and 10 years. At 10 years, patients who had undergone CACLR had lower KOOS than primary ACLRs ( p = 0.03). Concomitant injuries resulted in statistically, significantly poorer KOOS for both primary ACLRs and CACLRs preoperatively and at the follow‐ups. Conclusion: The PROMs for revision ACLRs have worse KOOS scores at 10 years compared with the primary ACLRs. The presence of concomitant meniscal or cartilage injuries at the time of ACLR or CACLR were associated with worse PROMs. Level of Evidence: Level III.

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