Older age, higher BMI, female sex and meniscal repair are predictors of inferior patient-reported outcomes 1 year after ACL reconstruction.

Abstract

To identify predictors of inferior patient-reported outcomes (PROs) 1 year after anterior cruciate ligament reconstruction (ACLR) and to examine whether these predictors differ by sex. We hypothesised that older age, female sex, and meniscectomy are associated with inferior PROs. We conducted a prospective cohort study involving 733 patients (396 males and 337 females) who underwent ACLR using autologous hamstring tendons. Participants were enroled in the Hiroshima Clinical ACL Research Project. Pre-operative assessments included demographic data, injury history, and scores from the five subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS). Additional assessments included the International Knee Documentation Committee (IKDC) subjective form, Lysholm score, and Tegner activity scale. Multivariable linear regression analysis was performed to identify predictors of KOOS subscale outcomes, including sex-specific subgroup analyses at 1 year postoperatively. Older age was a significant predictor of poorer KOOS outcomes across all subscales (p < 0.001). Higher body mass index (BMI) was also associated with inferior KOOS outcomes overall (p = 0.000-0.012). Female sex was significantly associated with worse outcomes on the KOOS Symptom (p = 0.003), Pain (p = 0.001), ADL (p = 0.002), and Sports/Recreation (p = 0.001) subscales. In female patients, higher BMI was significantly associated with all KOOS subscales (p = 0.000-0.007), while no such associations were observed in males. Medial meniscal repair was associated with significantly poorer KOOS Symptom (p < 0.001), Sports/Recreation (p < 0.001), and QOL (p = 0.018) scores. Lateral meniscal repair was significantly associated with worse KOOS Sports/Recreation (p = 0.003) and QOL (p = 0.005) scores. Contrary to our hypothesis, meniscectomy was not a significant predictor (p > 0.05). Older age, higher BMI, female sex, and meniscal repair were predictors of inferior PROs 1 year after ACLR. These findings underscore the importance of sex-specific preoperative counselling and postoperative management for patients at higher risk of suboptimal outcomes. Level II.