Lack of Knee Confidence Is Associated With Lower Functional Scores After Anterior Cruciate Ligament Reconstruction at 2-Year Follow-Up.

PURPOSE: To evaluate how patients rate their knee confidence after anterior cruciate ligament injury, when confidence in their knee returns after anterior cruciate ligament reconstruction (ACLR), and how knee confidence correlates with self-reported outcomes related to return to sport and activity.

METHODS: A retrospective analysis was done on a consecutive cohort of patients who underwent a primary ACLR with hamstring auto- and allograft between October 2012 and August 2022 with a minimum 2-year follow-up. Patients who had a concomitant ligament surgery, revision ACLR, quadriceps or bone-patellar tendon-bone autograft, concurrent osteotomy, or were missing Knee Injury and Osteoarthritis Outcome Score Question #41("How much are you troubled with lack of confidence in your knee?") at any timepoint were excluded. Patients were considered as lacking knee confidence if they answered "Moderately," "Severely," or "Extremely." The trend of lack of knee confidence from preoperative to 2-year postoperative timepoints was examined, and the associations between the lack of confidence and the Knee Injury and Osteoarthritis Outcome Score Sports/Rec subscale as well as the Marx Activity Rating Scale were explored.

RESULTS: A total of 165 patients met the inclusion criteria. Preoperatively, 88.5% of patients expressed a lack of confidence in their knees. This percentage declined, reaching 24.2% at 2 years post-ACLR. Age, sex, and graft type were not associated with knee confidence at any timepoint. Additionally, patients who expressed lack of knee confidence at 2 years postoperatively had significantly lower Marx Activity Rating Scale (4.7 vs 8.9, P < .001) and Knee Injury and Osteoarthritis Outcome Score Sport/Rec scores (58.1 vs 85.7, P < .001) and were less likely to have achieved minimal clinically important difference (70.6% vs 91.2%, P = .002) compared with those with confidence at 2 years postoperatively.

CONCLUSIONS: This study shows improvement in knee confidence post-ACLR with factors such as sex, age, graft type, and size having no notable impact. Lack of knee confidence correlates with lower functional scores at 2 years post-ACLR.

LEVEL OF EVIDENCE: Level III, retrospective comparative case series.