Anterior Cruciate Ligament Reconstruction Surgery Outcomes: A Comparison Between Patients Who Underwent the Procedure During the COVID-19 Pandemic and a Cohort Treated Prior to the Pandemic

Trevor D Wolterink; Michael A Gaudiani; Rami S Beydoun; Johnny K Kasto; Ryan Y Sanii; Vasilios Moutzouros; Stephanie Muh

doi:10.7759/cureus.57840

Anterior Cruciate Ligament Reconstruction Surgery Outcomes: A Comparison Between Patients Who Underwent the Procedure During the COVID-19 Pandemic and a Cohort Treated Prior to the Pandemic

Cureus. 2024 Apr 8;16(4):e57840. doi: 10.7759/cureus.57840. eCollection 2024 Apr.

Authors

Trevor D Wolterink¹, Michael A Gaudiani², Rami S Beydoun³, Johnny K Kasto², Ryan Y Sanii⁴, Vasilios Moutzouros², Stephanie Muh²

Affiliations

¹ Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, USA.
² Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, USA.
³ Department of Orthopaedic Surgery, Corewell Health East, Royal Oak, USA.
⁴ Department of Orthopaedic Surgery, Michigan State University College of Human Medicine, Lansing, USA.

Abstract

Background and objective During the coronavirus disease 2019 (COVID-19) pandemic, many elective orthopedic surgeries, including anterior cruciate ligament reconstruction (ACLR), were temporarily postponed. The purpose of this study was to compare the outcomes of ACLR in patients who underwent surgery during the COVID-19 pandemic with those in a cohort treated before the pandemic. Materials and methods This retrospective review compared patients who underwent primary ACLR during two periods: March to June 2020 (the pandemic group) and January to December 2018 (the pre-pandemic group). Matched cohorts (1:1) were created using propensity matching. Time from injury-to-first visit, injury-to-surgery, and first visit-to-surgery were calculated. Subjective and objective outcomes, minimal clinically important difference (MCID) achievement, and complication rates were recorded for up to two years postoperatively. Statistical analysis included 𝛘2 or Fisher's exact tests for categorical data, and t- or Wilcoxon signed-rank tests for continuous data with significance set at P < 0.05. Results The pandemic and pre-pandemic groups consisted of 33 and 217 patients, respectively. Matched cohorts consisted of 33 patients each. The time from injury-to-surgery and the first visit-to-surgery was prolonged in the pandemic group. When unmatched, visual analog scale (VAS) scores at three months postoperatively and Patient-Reported Outcomes Measurement Information System (PROMIS)-pain interference (PI) at six months postoperatively and at the final follow-up were higher in the pandemic group. When matched, PROMIS-PI at six months postoperatively was higher in the pandemic group, and VAS scores at one year postoperatively were higher in the pre-pandemic group. MCID achievement and complication rates did not significantly differ between the groups. Conclusions ACLR procedures were significantly delayed in the early months of the COVID-19 pandemic. While patients treated before and during the pandemic experienced varying pain levels during recovery, their functional outcomes, MCID achievement, and complication rates did not differ significantly.

Keywords: anterior cruciate ligament (acl); covid-19 pandemic; injuries; knee; knee arthroscopy; knee ligaments.