# Varus aligned patients have decreased patient reported International Knee Documentation Committee, knee injury and osteoarthritis outcome score sports scores and Tegner activity levels compared to neutral aligned patients in primary anterior cruciate ligament reconstructions

## TL;DR

Patients with varus knee alignment had worse outcomes after ACL surgery compared to those with neutral alignment, based on self-reported scores.

## Contribution

This study shows that varus alignment is linked to clinically meaningful worse outcomes after ACL reconstruction.

## Key findings

- Varus alignment patients had significantly lower International Knee Documentation Committee scores compared to neutral alignment patients.
- Tegner activity levels were significantly lower in varus alignment patients compared to neutral alignment patients.
- No significant differences were found between other coronal or sagittal alignment groups.

## Abstract

The purpose was to evaluate the impact of coronal or sagittal alignment on patient‐reported outcomes after primary anterior cruciate ligament reconstruction (ACLR). The hypothesis was that coronal or sagittal alignment would not significantly influence 2‐year outcomes after a primary ACLR.

Eighty patients with a mean age of 30.9 were included in this retrospective case series. Patients who underwent primary ACLR and at least 2 years of follow‐up completed the International Knee Documentation Committee survey, knee injury and osteoarthritis outcome score, Tegner activity level and the lysholm knee scoring scale. Scores were compared between varus, neutral and valgus alignments, as well as patients with a posterior tibial slope ≥12° or <12°. Independent two‐tailed t‐tests determined significant differences between the groups.

The primary outcome was patients with varus alignment had significantly decreased postoperative International Knee Documentation Committee survey (80.18) (p = 0.010), knee injury and osteoarthritis outcome score: Sports and rec (75.40) (p = 0.036) and Tegner activity level (6.00) (p = 0.002) scores compared to patients with neutral alignment (88.11, 85.37 and 7.61, respectively). No other groups showed a significant difference. A secondary outcome showed no significant difference between increasing coronal alignment deformity from neutral (180°) and patient‐reported outcomes.

The primary outcome demonstrated significantly higher postoperative International Knee Documentation Committee Survey, knee injury and osteoarthritis outcome score: sports and recreation, and Tegner score in the neutral compared to the varus alignment groups, with knee injury and osteoarthritis outcome score: sports and recreation and Tegner score surpassing the minimally clinically important difference. No significant differences were observed between other coronal or sagittal groups. These findings suggest that varus alignment may be associated with clinically meaningful differences in patient outcomes compared to neutral alignment after primary ACLR.

Level III, retrospective case series.

This graphical abstract illustrates a comparison of patient‐reported outcome measures in patients undergoing primary anterior cruciate ligament reconstruction (ACLR). It compares outcomes across coronal and sagittal knee alignment groups. Patients with varus alignment demonstrated significantly lower International Knee Documentation Committee, knee injury and osteoarthritis outcome score, sports and recreation and Tegner activity scores compared to those with neutral alignment, while no other differences were observed in coronal or sagittal alignment. These findings suggest that native varus alignment may be associated with inferior patient‐reported outcomes following primary ACLR.