Patient Participation During Anterior Cruciate Ligament Reconstruction Improves Comprehension, Satisfaction, and Functional Outcomes: A Simple Way to Improve Our Practices

Abstract

Background: It is estimated that 28% of patients are dissatisfied after anterior cruciate ligament (ACL) reconstruction, in part because they do not understand the procedure well enough. Purpose: To assess the postoperative comprehension, satisfaction, and functional outcomes of 2 patient groups: 1 undergoing a standard surgical procedure (standard group) and 1 involved in their surgery (participation group). Study Design: Cohort study; Level of evidence, 2. Methods: Over a 4-month period, 62 patients were included: 31 in the standard group and 31 in the participation group. The preoperative information, surgical technique, anesthesia, and postoperative course were identical in both groups. Patients in the participation group were allowed to watch the arthroscopic portion of their surgery live on a video screen, and standardized information was given to these patients during the arthroscopic phase. Self-administered questionnaires were given to assess comprehension (Matava score), satisfaction (visual analog scale [VAS] for satisfaction, Net Promoter Score [NPS], and Evaluation du Vécu de l’Anesthésie LocoRégionale [EVAN-LR]), and outcomes (International Knee Documentation Committee [IKDC] form and Anterior Cruciate Ligament–Return to Sport after Injury [ACL-RSI] scale) between groups. Results: Postoperative comprehension was significantly improved in the participation group, as the Matava score increased by a mean of 7.1 ± 5.3 points versus 2.7 ± 5.6 points in the standard group (P =.0024). The mean VAS satisfaction score immediately after surgery was 9.8 ± 0.6 in the participation group versus 8.9 ± 1.9 in the standard group (P =.0033); this difference was still present at 1 year postoperatively (9.8 ± 0.6 vs 9.1 ± 1.7, respectively; P =.0145). The NPS was 96.8% in the participation group versus 64.5% in the standard group (P =.0057) in the immediate postoperative period and 100.0% in the participation group versus 71.0% in the standard group at 1 year postoperatively (P =.0046). The mean total EVAN-LR score was 89.1 ± 6.5 in the participation group and 84.6 ± 9.9 in the standard group (P =.0416). At 1 year postoperatively, the mean IKDC score was 86.0 ± 7.5 in the participation group versus 80.0 ± 7.4 in the standard group (P =.0023). The mean ACL-RSI score was 80.9 ± 7.7 in the participation group versus 74.3 ± 8.4 in the standard group (P =.0019). Conclusion: Involving patients in their ACL reconstruction surgery improves their understanding of the procedure and their satisfaction with their care, which results in better outcomes at 1 year postoperatively.