Meniscus or Cartilage Injury at the Time of Anterior Cruciate Ligament (ACL) Tear are Associated With Worse Prognosis for Patient-Reported Outcome 2 to 10 Years After ACL Injury: A Systematic Review.

OBJECTIVES (1) To assess prognostic factors for patient-reported outcome measures (PROMs) and physical activity two to ten years after anterior cruciate ligament reconstruction (ACLR) or injury, and (2) to assess differences in prognostic factors between patients treated with ACLR and with rehabilitation alone. DESIGN Prognosis systematic review. LITERATURE SEARCH Systematic searches in PubMed, Web of Science and SPORTDiscus. STUDY SELECTION CRITERIA We selected prospective cohort studies and randomised clinical trials that included adults/adolescents undergoing either ACLR or rehabilitation alone after ACL rupture. Studies had to assess for a statistical association between potential prognostic factors (factors related to patient characteristics, injury or knee symptoms/function measured at baseline or within one year) and outcomes (PROMS and physical activity). DATA SYNTHESIS Our search yielded 1008 references. Twenty studies met inclusion criteria. Seven studies with low or moderate risk of bias remained for data synthesis. RESULTS There was moderate certainty evidence that concomitant meniscus and cartilage injuries were prognostic factors for worse PROMs two to ten years after ACLR. There was very low certainty evidence that BMI, smoking and baseline PROMs were prognostic factors for worse outcome. There was very low certainty evidence that female sex and worse baseline Marx Activity Rating Scale (Marx) were prognostic factors for worse Marx two to ten years after ACLR. There was a lack of studies on prognostic factors after rehabilitation alone. CONCLUSION Concomitant meniscus and cartilage injuries were prognostic factors for worse long-term PROMs after ACLR. The certainty was very low for other prognostic factors. J Orthop Sports Phys Ther, Epub 1 Aug 2020. doi:10.2519/jospt.2020.9451.