Here are my disclosures. I am presenting this today on behalf of the Moon Knee Group, whose members and current support staff are listed here. The goal for every surgeon and patient is to have a successful surgery. The definition of success, however, may be slightly different between surgeon and patient. Ultimately, it's the patient's definition that matters, and thus the impetus of the development of patient-reported outcome measures, or PROMs. Currently, interpreting the various patient-reported outcome measures that are available is not always straightforward to evaluate success of a surgery, but it's critical to know. To address this issue, at least two groups have developed a validated question of success from a patient's perspective, both the Pittsburgh Group and the Norwegian Ligament Registry Group. We adopted Dr. Mueller and Erging's version for which the question reads, taking into account all the activity you have during your daily life, your level of pain, and also your activity limitations and participation restrictions, do you consider the current state of your knee satisfactory, yes or no? The purpose of this study was threefold. We wish to determine the percentage of ACL reconstructed patients who are satisfied with their knee or who responded yes to this past outcome measure, 10 years following their ACL surgery. To correlate the past question, second aim was to correlate the past question with our existing PROMs that we've used for this cohort for the last 10 years, which includes the IKDC, COOS, and Mark's activity level scores. Lastly, we wish to predict which variables lead to a patient being dissatisfied with their ACL surgery 10 years later. This was part of a large longitudinal cohort where we asked 396 subjects during one enrollment year to answer the single satisfaction question as part of their 10-year follow-up. As part of the study's established protocol, patients were asked to complete a series of patient-reported outcome measures at the time of their ACL surgery, and then again at two, six, and 10 years following this index surgery. Surgeons were also asked to complete a questionnaire at the time of the subject's surgery regarding graft choice, meniscal and articular cartilage pathology, and treatment, as well as the surgical technique. Regression models were built in order to control for demographic and surgical factors, as well as baseline patient-reported outcome measures. There were 325 subjects who completed the survey, equating to an 82% follow-up rate. The median age at the time of the 10-year follow-up was 33 years. We found that 87% of the subjects reported being satisfied with their current state of their knee at 10 years. Alternatively, 13% reported dissatisfaction. There was a significant difference in all 10-year patient-reported outcome scores between the patients who were satisfied with their knee, who answered yes on the PASS, versus those who weren't or answered no on the PASS. Using area under curve plots, we can determine which PROMs best correlate with the PASS question. I realize this slide is busy, but you're looking for the IKDC and the COOS quality of life scores best correlated with patient satisfaction at 10 years. Conversely, the MARCS activity score had the poorest correlation. Using regression modeling, we found that patients who had any sort of subsequent surgery were 2.5 times more likely to report dissatisfaction. Groups from the Cleveland Clinic and Pittsburgh have reported similar patient satisfaction results at 1 to 2 years, while the Norwegian and the Swedish National Registries have reported lower patient satisfaction results at 1 to 2 years in the neighborhood of about 60%. Threshold values for PROMs in the PASS question have previously been reported and developed by other groups. It may be that factors which impact whether a patient is satisfied or not may change over time. And in conclusion, in our cohort, we found a high percentage of patients, 87%, remain satisfied with their knee 10 years after their ACL reconstruction. The IKDC and the COOS quality of life instruments were the best proxies for the PASS at 10 years. And lastly, the major risk factor for patient dissatisfaction was having any subsequent surgery. Thank you.

patient satisfaction

patient-reported outcome measures

PROMs

ACL surgery

patient dissatisfaction