Description
Objectives: Loss of motion is a challenging complication following primary anterior cruciate ligament reconstruction (ACLR) as it often requires additional surgical management, limits function, and affects long-term outcomes including the risk of osteoarthritis. Studies on risk factors for subsequent surgical procedures for loss of motion are limited compared to reports of risk factors for other complications such as revision ACLR. Therefore, the purpose of this study was to identify risk factors associated with a subsequent surgical procedure for loss of motion following primary ACLR using data from the electronic health record (EHR) of a large single-system health network.
Methods: Data for individuals (>14 years old) who underwent primary ACLR between January 2013 and June 2021 were extracted from the EHR. Potential patient and surgical predictors were identified from structured data and/or extracted from the ACLR operative report using validated natural language processing methods. A Cox proportional hazards model was used to identify factors associated with the risk of a subsequent surgical procedure for loss of motion, including manipulation under anesthesia, arthroscopic debridement, and/or arthrolysis of adhesions. (p < 0.05). Hazards ratios (HR) and 95% confidence intervals (CI) are reported.
Results: From an initial sample of 6,121 individuals, 3,478 (median age 21.8 years [IQR 17.4, 32.9]; 44.2% female) underwent primary ACLR and were eligible for this study. Overall, 3.2% of individuals underwent a subsequent surgical procedure for loss of motion at a median of 119 days (interquartile range 83-192) after primary ACLR. The incidence rate of subsequent procedure for loss of motion was 2.7 per 100 person-years. Risk factors for a subsequent procedure for loss of motion included Black race (HR: 2.6, CI: 1.7-3.9), female sex (HR: 2.2, CI: 1.5-3.3), lateral meniscus repair (HR: 2.2, CI: 1.4-3.4) and quadriceps tendon autograft (HR: 1.9, CI: 1.1-3.6), while medial meniscectomy (HR: 0.43, CI: 0.2-0.9) was found to be protective compared with no medial meniscus surgery (Table 1).
Conclusions: Black race, female sex, lateral meniscus repair, and quadriceps tendon autograft were associated with increased risk of a subsequent surgical procedure for loss of motion. Consideration of such risk factors may better inform patient education, clinical practice, and post-operative rehabilitation following ACLR.
