Editorial Commentary: Second-Look Arthroscopic Evaluation of Graft Incorporation Following Anterior Cruciate Ligament Reconstruction Fails to Reveal Structural Causes of Poor Patient-Reported Outcomes.

Outcomes following anterior cruciate ligament reconstruction (ACLR) have been studied for years, elucidating specific factors such as graft type, sport, sex, technique, and functional factors that affect those outcomes. Multiple patient-reported outcome measurement (PROM) tools have been developed and validated to quantify patient experience and allow objective comparisons. Postoperative weakness is a known issue following ACLR and has been shown to impact PROMs. Postoperative functional strength deficits are not limited to patellar and quadriceps autograft alone, with deficits seen following all autograft and allograft reconstructions. Another factor believed to influence PROMs following ACLR is graft incorporation, which has been studied radiographically and, more recently, by postoperative arthroscopy. So-called second-look arthroscopy protocols in published studies can be variable, and to this point, graft incorporation scoring systems have been suggested. These have not been validated or proven to correlate with changes in PROMs following ACLR.