Primary ACL Reconstruction Among Service Members: A MOTION Cohort Analysis- SOMOS 2025

d tennent, a sheean

Abstracted accepted for a rapid-fire presentation at the 2025 Society of Military Orthopaedic Surgeons Annual Meeting.

INTRODUCTION: Previous studies reporting on outcomes of anterior cruciate ligament (ACL) reconstruction (ACLR) among military Service Members (SM) have indicated that a substantial proportion of patients do not return to full, unrestricted activities. However, owing to conspicuous limitations in methodology and outcomes reporting of these studies, it has been difficult to draw substantive conclusions about the prevalence of concomitant injuries, the type and frequency of specific treatments, and predictors of patients’ baseline pain and function. The Military Orthopaedic Tracking Injuries and Outcomes Network (MOTION) provides an infrastructure for the prospective collection of baselines, injury-related information including patient reported outcome measures (PROMs) and intra-operative details. The current study is part of a broader collaborative effort between MOTION and the Multicenter Orthopaedic Outcomes Network (MOON) Knee Group to more rigorously predict the outcomes of primary ACLR among SM. We are unaware of previous efforts to employ MOTION to characterize baseline clinical information related to primary ACLR among Service Members. Therefore, the purpose of the current study was to report on the contents of MOTION database to describe: 1. Patients’ baseline, injury-specific PROMs, 2. The prevalence of concomitant injuries, and 3. Military surgeons’ treatment approaches with respect to graft type and management of concomitant chondral and meniscal injuries.

METHODS: MOTION was queried using the current procedure terminology (CPT) code 29888 to compile a list of all primary and revision ACLR as well as primary ACL repairs performed by MOTION surgeons between 2016 and 2023. A fellowship trained surgeon (X.X.X.) reviewed all operative reports, noting graft type, primary v. revision ACLR, primary ACL repair, graft type, presence or absence of meniscal tears, meniscus tear treatments, presence or absence of chondral injuries, and chondral injury treatments. All SM undergoing primary ACLR with operative reports available for review and baseline Single Assessment Numeric Evaluation (SANE), Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF), PROMIS Pain Interference (PI), International Knee Documentation Committee (IKDC) scores were included in the final analysis.

RESULTS: One thousand one hundred and nineteen patient records with CPT code 29888 were extracted from the MOTION. After applying the aforementioned inclusion criteria, 552 ACLR (551 patients) were included. There were 404 males (73.3%) and 148 females (26.7%) with a mean age of 28.2 years ± 7.6 years (range: 18-59 years.) Mean PROMs prior to ACLR were; PROMIS PF: 42.5 ± 6.2, PROMIS-PI: 57.5 ± 6.6, IKDC: 49.2 ± 14.4, SANE: 42.6 ± 22.1. Primary ACLR was performed using autograft bone patellar tendon bone in 303 (54.8%) cases, quadriceps tendon in 150 (27.3%) cases, hamstring in 52 (9.4%) cases, and allograft in 47 (8.5%) cases. Concomitant meniscus tears were noted in 341 (61.8%) cases (isolated medial tears: 121 (21.9%), isolated lateral tears: 143 (25.9%), combined medial/lateral tears: 77 (13.9%.) Sixty five of 121 (53.7%) isolated medial meniscus tears were repaired, and 68 of 143 (47.6%) isolated lateral meniscus tears were repaired. The majority of isolated medial and lateral meniscus tears were repaired via an all-inside technique (93 of 133, 69.9%.) Thirteen lateral meniscus root tear repairs were performed via transosseous tunnel technique. Concomitant chondral injuries were noted in 206 (37.3%) cases, the majority of which were Grade 1 lesions (100 of 206, 48.5%.) No treatment was performed in the majority (218 of 330, 66%) of chondral lesions.

DISCUSSION and CONCLUSION: This is the first description of MOTION ACLR with respect to baseline PROMs data, graft type, prevalence of meniscus/chondral injuries, and treatment frequencies. The prevalences of concomitant meniscus/chondral injuries were similar to what has been reported among comparable civilian cohorts undergoing ACLR. The prevalence of lateral meniscus posterior root injuries was substantially less than what has previously been reported in the literature. Subsequent analyses of these data will clarify the most significant predictors of patients’ baseline pain and function.