Purpose
To determine whether subgroups of patients exist based on the rate-of-recovery pattern
of International Knee Documentation Committee (IKDC) scores after anterior cruciate
ligament reconstruction (ACLR) and to determine clinical predictors for these subgroups.
Methods
Patients who underwent primary or revision ACLR at a single institution from January
2014 to January 2019 were identified. Latent class growth analyses and growth mixture
models (GMMs) with 1 to 6 classes were used to identify subgroups of patients based
on functional rate-of-recovery patterns by use of preoperative, 1-year postoperative,
and 2-year postoperative IKDC scores.
Results
A total of 245 patients who underwent ACLR were included in the analysis. A 3-class
GMM was chosen as the final model after 6 different models were run. Class 1, showing
improvement from preoperatively to 1-year follow-up, with sustained improvement from
1 to 2 years postoperatively, constituted 77.1% of the study population (n = 189),
whereas class 2, showing functional improvement between 1- and 2-year follow-up, was
the smallest class, constituting 10.2% of the study population (n = 25), and class
3, showing slight improvement at 1-year follow-up, with a subsequent decline in IKDC
scores between 1- and 2-year follow-up, constituted 12.7% of the study population
(n = 31). Revision surgery (P = .005), a psychiatric history (P = .025), preoperative chronic knee pain (P = .024), and a subsequent knee injury within the follow-up period (P = .011) were the predictors of class 2 and class 3 rate-of-recovery patterns. Patient
demographic characteristics, graft type, and concomitant ligament, meniscus, or cartilage
injury at the time of surgery were not associated with the different recovery patterns
described in this study.
Conclusions
Patients may follow different rate-of-recovery patterns after ACLR. By use of the
GMMs, 3 different rate-of-recovery patterns based on IKDC scores were identified.
Although most patients follow a more ideal rate-of-recovery pattern, fewer patients
may follow less favorable patterns. Revision surgery, a history of psychiatric illness,
preoperative chronic knee pain, and a subsequent knee injury within the follow-up
period were predictive of less favorable rate-of-recovery patterns.
Level of Evidence
Level III, retrospective cohort study.
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Article Info
Publication History
Published online: March 22, 2022
Accepted:
February 25,
2022
Received:
November 6,
2021
Footnotes
See commentary on page 2491
The authors report the following potential conflicts of interest or sources of funding: B.R.B. receives research support from Arthrex , ConMed Linvatec, DJ Orthopaedics, Ossur, SLACK, Smith & Nephew, and Tornier, outside the submitted work. C.A.B-J. owns stock or stock options in Cresco Lab, outside the submitted work; is on the editorial or governing board of American Journal of Sports Medicine; and is a board or committee member of American Orthopaedic Society for Sports Medicine (AOSSM). B.F. receives research support from Arthrex , Smith & Nephew, and Stryker; receives publishing royalties and financial or material support from Elsevier; owns stock or stock options in iBrainTech, Jace Medical, and Sparta Biopharma; is a paid consultant for Smith & Nephew and Stryker; is a board or committee member of AOSSM; and is on the editorial or governing board of Video Journal of Sports Medicine. A.B.Y. receives personal fees from ConMed Linvatec, JRF Ortho, and Olympus; receives grants from Organogenesis, Vericel, and Arthrex; owns stock or stock options in PatientIQ; and receives nonfinancial support from PatientIQ, Smith & Nephew, and Sparta Biomedical. N.N.V. is a board or committee member of AOSSM , American Shoulder and Elbow Surgeons , and AANA; receives research support from Arthrex , Breg, Ossur, Smith & Nephew, and Wright Medical Technology; receives publishing royalties and financial or material support from Arthroscopy and Vindico Medical–Orthopedics Hyperguide; owns stock or stock options in Cymedica, Minivasive, and Omeros; is on the editorial or governing board of Knee and SLACK; is a paid consultant for Minivasive and Orthospace; and receives intellectual property royalties from Smith & Nephew, outside the submitted work. B.J.C. receives research support from Aesculap, National Institutes of Health , Regentis, and Arthrex; is a paid consultant for Aesculap, Regentis, Arthrex , Acumed , and Vericel; receives other financial or material support from Aesculap, Smith & Nephew, Arthrex , Encore Medical, GE Healthcare , Merck Sharp & Dohme , SportsTek Medical, and Vericel; receives publishing royalties and financial or material support from Operative Techniques in Sports Medicine; owns stock or stock options in Ossio, Regentis, and Bandgrip; receives royalties from Arthrex; and receives intellectual property royalties from Elsevier, outside the submitted work. J.C. is a paid consultant for Arthrex , ConMed Linvatec, Ossur, and Smith & Nephew, outside the submitted work, and is a board or committee member of AOSSM , AANA , and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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