Summary

Compared to non-skiers, skiers demonstrated significantly increased mean improvements in KOOS scores between 2 and 6 years following ACLR. Additionally, skiers = 40 years show greater improvement in KOOS quality of life compared to younger skiers. This information can be used to counsel skiers, especially those over 40 years, as to their expected outcomes following ACLR.

Abstract

Introduction

There remains a paucity of literature comparing outcomes following anterior cruciate ligament reconstruction (ACLR) among skiers versus non-skiers, particularly in older patient populations. The purpose of this study was to compare outcomes following ACLR between skiers versus non-skiers, with a sub-analysis based on age.

Methods

A nested cohort of 128 patients from the Multicenter Orthopaedic Outcomes Network cohort who underwent primary ACLR completed a series of validated outcome instruments preoperatively and postoperatively at 2 and 6 years, including the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Marx Activity Rating Scale, and International Knee Documentation Committee (IKDC) score. Data including patient sex, age at surgery, graft type, and sport participation was collected and analyzed. Patients were stratified by participation in skiing (skiers vs. non-skiers) and by age subgroup (<= 29, 30-39, and >= 40 years). Student t-tests were used to compare preoperative and postoperative outcome scores between skiers and non-skiers. A one-way analysis of variance was used to compare preoperative and post-operative outcome measures within the different age groups of skiers.

Results

Forty-four skiers (59.1% female, 35.3 ± 11.6 years of age) and 84 non-skiers (34.5% female, 27.7 ± 11.3 years of age) were included. ACLR was performed with allograft in 36.7% (22 skiers; 25 non-skiers), autograft in 58.6% (19 skiers; 56 non-skiers) or hybrid autograft-allograft in 4.7% (3 skiers; 3 non-skiers). Skiers demonstrated significantly increased mean improvement from baseline to 6 years in the KOOS symptoms (p=0.037) and KOOS sport (p=0.046) compared to non-skiers. Although both non-skiers and skiers demonstrated improvements in outcomes from baseline to 2 and 6 years, non-skiers demonstrated a significant decrease in overall improvement from 2 to 6 years postoperatively. Whereas, between 2 and 6 years postoperatively, skiers demonstrated significantly increased mean improvement in KOOS symptoms (p=0.012), KOOS pain (p=0.002) and KOOS activity of daily living (p=0.026) compared to non-skiers. There were no significant differences between groups in mean improvement at 2 years in any outcome measure (p>0.05), nor at 6 years in the Marx activity (p=0.234), and IKDC (p=0.241). There were 15 skiers <= 29 years of age (34%), 14 skiers between 30-39 (32%), and 15 skiers >= 40 (34%). Skiers >= 40 demonstrated a significant mean improvement in KOOS symptoms (p=0.024) and KOOS quality of life (QoL) (p=0.008) at 2 years postoperatively compared to skiers ages 30-39 and <= 29. Skiers >= 40 also demonstrated a significant mean improvement at 6 years in the KOOS QoL (p=0.014) compared to skiers ages 30-39 years and skiers <= 29 years. Between 2 and 6 years postoperatively, there were no significant differences observed in skiers based on age in the KOOS, Marx activity or IKDC outcome measures (p>0.05).

Conclusion

Compared to non-skiers, skiers demonstrated significantly increased mean improvements in KOOS scores between 2 and 6 years following ACLR. Additionally, skiers >= 40 years show greater improvement in KOOS quality of life compared to younger skiers. This information can be used to counsel skiers, especially those over 40 years, as to their expected outcomes following ACLR.