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Investigating the Precision and Accuracy of Subjective Patient and Surgeon Expectations following Anterior Cruciate Ligament Reconstruction

      Introduction

      Advances in orthopaedic surgery have redefined patients' perception of the successful outcome. Recent literature suggests that patient satisfaction following orthopaedic surgery is related to their outcome and their preoperative expectation. However, patients undergoing ACLR may have unrealistic expectations which may contribute to worse outcomes and reduced patient satisfaction. The purpose was to compare patient’s expectations and surgeon’s expectation using validated outcome assessment tools as expectation questionnaires. Actual patient outcomes were tracked to determine accuracy of the expectations.

      Methods

      All patients undergoing primary ACLR for ACL tear were eligible. Patients completed IKDC and Lysholm knee questionnaires pre-operatively and at 3 and 6 months postoperatively. Before surgery patients completed a second set of IKDC and Lysholm knee questionnaires pertaining to how they expect their knee to feel in 18 months. Immediately post-operatively, surgeons completed a set of IKDC and Lysholm questionnaires representing how they expected the patient to fare in 18 months.

      Results

      76 consecutive patients were enrolled. Pre-operatively, patient average Lysholm and IKDC scores were, 55.27 and 45.0%. Analysis of Lysholm score revealed patient’s reported expectations significantly higher (mean = 94.9) than surgeons (mean= 92.6) (p= <.001). The average difference between patient and surgeon expectations was 10.9 points. Analysis of IKDC scores revealed the same trend; patient (92.3%) vs. surgeon (91.8%) expectations. 58/76 patients reached 6 month follow-up, 42 completed Lysholm and IKDC questionnaires and the average reported scores are 84.9 and 74.5%. No correlation between 6-month outcome scores and pre-operative expectations has yet to be shown.

      Conclusion

      When using validated outcome measures to determine expectations, patients have higher expectations than surgeons with regard to ultimate function and pain after ACLR. This study is the first to assess the differences in expectations of patients v. surgeons prior to ACLR. Further data collection will determine if any correlation of expectation to ultimate outcome is observed.