Patients Can Expect to Stay Active, Enjoy High Quality of Life 10 Years after ACL Surgery

    Researchers from the Multicenter Orthopaedics Outcome Network (MOON) have demonstrated that patients can continue to perform sports-related functions and maintain a good knee-related quality of life at least a decade after reconstruction of a torn anterior cruciate ligament (ACL), although activity levels decline over time.

    The study, presented at the American Orthopaedic Society for Sports Medicine’s Annual Meeting in Toronto, Ontario, Canada, received the O’Donoghue Sports Injury Research Award. It is the first prospective study of ACL reconstruction with more than 80% follow-up at 10 years.

    Researchers at 7 sites in the MOON Group identified and enrolled 1597patients who underwent unilateral ACL reconstruction between 2002 and 2004. Of those treated, 90% had a primary ACL reconstruction and 10% had a revision ACL reconstruction. Graft choice was 42% autograft bone-patellar-bone, 31% autograft soft tissue, and 27% allograft.  

    Before surgery, patients completed several validated outcome instruments, including the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Marx activity scale. These were repeated at 2-, 6-, and 10-year follow-ups. Of the original group, 1320 patients were available for the 10-year follow-up.

    “Our data show significant improvements in patient-reported outcome measures from IKDC and KOOS 2 years after surgery, which were maintained at 6 and 10 years,” said lead author Kurt P. Spindler, MD, from the Cleveland Clinic.

    “These improvements were noted across a substantial population of 1320 patients, who made up 83% of our original study group.”

    Factors associated with worse outcomes within the study population included:

    • Lower baseline scores on the outcomes instruments
    • Higher body mass index
    • Smoking
    • History of meniscus surgery
    • Revision ACL reconstruction
    • Grades 3-4 articular cartilage pathology in the medial, lateral, and patellofemoral compartments
    • Subsequent ipsilateral surgery

    The researchers found that graft type, pathology in the medial or lateral collateral ligament, and medial or lateral meniscus surgery in conjunction with the ACL reconstruction were not significant risk factors for poor outcomes.

    “An active patient may view an ACL injury as devastating, but our research adds to short- and long-term studies that show a good prognosis for return to pre-injury quality of life,” Dr. Spindler said.

    “This can help medical providers continue to make good treatment decisions and present these injuries as simply a setback.”


    Spindler KP, Huston LJ, MOON Knee Group. 10 Year Outcomes and Risk Factors after ACL Reconstruction: A Multicenter Cohort Study (paper 140). Winner of the O’Donoghue Sports Injury Award. Presented at the Annual Meeting of the American Orthopaedic Society for Sports Medicine, July 20-23, 2017, Toronto, Ontario, Canada. All abstracts from the meeting can be found here.