A composite test 6 months after an Anterior Cruciate Ligament Reconstruction cannot predict graft failure: A prospective analysis of 498 patients with a mean 5-year follow-up from MERIScience cohort.

Purpose: The aim of this study was to investigate a correlation between various components of the composite test and graft failure at mid-term follow up after an Anterior Cruciate Ligament (ACL) reconstruction.

Methods: This single-center study includes patients who underwent primary ACL reconstruction surgery and received an identical 6-months postoperative composite evaluation at the institution (isokinetic tests, jump tests and ACL - Return to Sport and Injury (RSI) psychological evaluation) between 2017 and 2020. To be eligible, a minimum follow-up period of 3 years was necessary, with evaluations conducted at the longest follow-up interval to assess the rates of graft failure.

Results: Overall, 498 patients were analyzed, with a mean follow-up of 4.9 ± 1.23 years. The overall ACL graft failure rate was 5.4% (27 patients). The mean ACL-RSI at 6 months was 64.9 ± 19.4% for patients without graft failure, compared to 60.8 ± 16.3% for patients who experienced graft failure. No statistically significant difference was observed between the two groups (p > 0.05). There was no statistically significant between-group difference for any of the other composite test items (p > 0.05).

Conclusion: The composite test performed 6 months after an ACL reconstruction was not predictive of the risk of graft failure. Although it can be used to guide recovery and re-athletization, other predictive factors for the risk of graft failure, or a modification of the test items, should be considered for post-operative follow-up and evaluation after ACL reconstruction. Doctors should strive to readjust patients' expectations of these composite tests, which appear to be useful only for assessing a return to sport.

Level of evidence: IV; Case-control study.