Determinants of Patient Satisfaction with Outcome After Anterior Cruciate Ligament Reconstruction

M. Kocher, J. Steadman, K. Briggs, D. Zurakowski, W. Sterett, R. Hawkins
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引用次数: 348

Abstract

Background: The purpose of this study was to identify the determinants of patient satisfaction with the outcome after reconstruction of the anterior cruciate ligament.Methods: A cohort of 201 patients undergoing primary reconstruction of the anterior cruciate ligament was studied prospectively. All patients were followed for a minimum of two years (mean, 35.9 months). The dependent variable was patient satisfaction with the outcome, graded ordinally on a scale of 1 to 10. Nonparametric univariate analysis and multivariable modeling were performed to identify determinants of satisfaction.Results: The demographic variables were not found to have a significant association (p > 0.05) with patient satisfaction. The variables at surgery demonstrated a significant association (p < 0.05) with patient satisfaction only with respect to the status of the lateral meniscus, the presence of osteophytes, and concurrent plica excision. The objective variables at follow-up revealed that patients were significantly less satisfied (p < 0.05) if they had a flexion contracture, increased laxity of the involved leg on the manual maximum test as measured on a KT-1000 device, an abnormal result on the pivot-shift examination, effusion, or tenderness at the medial joint line or patella. With regard to the subjective symptoms at follow-up, patients were found to be significantly (p < 0.05) less satisfied with the outcome if they had symptoms of pain, swelling, partial giving-way, full giving-way, locking, noise, stiffness, or a limp. Analysis of the subjective function at follow-up demonstrated that patients were significantly less satisfied (p < 0.05) with the outcome if they had a lower level of activity, sports activity, strenuous work, activities of daily living, overall knee function, sports participation, or symptom-free activity; if they were unemployed; or if they had difficulty with walking, squatting, ascending or descending stairs, running, jumping, cutting, or twisting. Patient satisfaction was significantly associated (p < 0.05) with the Lysholm knee score, overall International Knee Documentation Committee (IKDC) knee score, IKDC subjective subscore, IKDC symptoms subscore, and IKDC range-of-motion subscore. The seven independent multivariate determinants (adjusted R 2 = 0.83, p < 0.001) of patient satisfaction included the Lysholm score, overall subjective knee function, IKDC range-of-motion subscale, patellar tenderness, full giving-way, flexion contracture, and swelling.Conclusions: Univariate and multivariate determinants of patient satisfaction with the outcome after reconstruction of the anterior cruciate ligament were established. Although some specific surgical and objective variables were important, subjective variables of symptoms and function had the most robust associations with patient satisfaction. In assessing the outcome of reconstruction from the perspective of patient satisfaction with the outcome, we should emphasize patient-derived subjective assessment of symptoms and function, particularly those involving issues of stiffness, giving-way, swelling, and patellofemoral symptoms.
前交叉韧带重建后患者满意度的决定因素
背景:本研究的目的是确定前交叉韧带重建后患者满意度的决定因素。方法:对201例行前交叉韧带重建术的患者进行前瞻性研究。所有患者至少随访2年(平均35.9个月)。因变量是患者对结果的满意度,按1到10的等级依次评分。采用非参数单变量分析和多变量建模来确定满意度的决定因素。结果:人口学变量与患者满意度无显著相关(p > 0.05)。手术变量显示,仅在外侧半月板状态、骨赘的存在和同时的皱襞切除方面,患者满意度与手术变量有显著相关性(p < 0.05)。随访的客观变量显示,如果患者有屈曲挛缩,在KT-1000装置上测量的手动最大测试中,受累腿的松弛程度增加,枢轴移位检查结果异常,积液或内侧关节线或髌骨压痛,则患者满意度显著降低(p < 0.05)。在随访时的主观症状方面,出现疼痛、肿胀、部分让位、完全让位、锁定、噪音、僵硬、跛行等症状的患者对结果的满意度明显较低(p < 0.05)。随访时的主观功能分析显示,活动量、运动活动、剧烈工作、日常生活活动、整体膝关节功能、运动参与或无症状活动水平较低的患者对结果的满意度显著降低(p < 0.05);如果他们失业了;或者他们行走、下蹲、上下楼梯、跑步、跳跃、切割或扭转有困难。患者满意度与Lysholm膝关节评分、国际膝关节文献委员会(IKDC)膝关节评分、IKDC主观评分、IKDC症状评分和IKDC活动范围评分显著相关(p < 0.05)。患者满意度的七个独立的多因素决定因素(调整后r2 = 0.83, p < 0.001)包括Lysholm评分、总体主观膝关节功能、IKDC活动范围亚量表、髌骨压痛、完全让位、屈曲挛缩和肿胀。结论:确定了前交叉韧带重建后患者满意度的单因素和多因素决定因素。虽然一些特定的手术和客观变量很重要,但症状和功能的主观变量与患者满意度的关系最为密切。从患者对结果的满意度角度评估重建结果时,我们应该强调患者对症状和功能的主观评估,特别是那些涉及僵硬、让位、肿胀和髌股症状的问题。
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