Determining the Substantial Clinical Benefit Values for Patient-Reported Outcome Scores After Primary ACL Reconstruction

Abstract

Background: Little is known about the threshold of patient-reported outcomes (PROs) at which patients perceive to have attained a substantial clinical benefit (SCB) after anterior cruciate ligament reconstruction (ACLR). Purpose: To determine the SCB value of PROs 1 year after ACLR in the general population and to determine factors that predict SCB attainment. Study Design: Case series; Level of evidence, 4. Methods: The Lysholm, International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF), Tegner, and Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scores were examined postoperatively in 88 patients who underwent ACLR. At the 12-month follow-up visit, the patients answered 2 independent anchor questions about daily discomfort and functional recovery. Receiver operating characteristic (ROC) curve analysis was used to differentiate PRO scores between patients who responded as having no difficulty versus some difficulty with daily knee discomfort (anchor question 1) and between patients with substantial recovery versus nonsubstantial recovery of knee function (anchor question 2). The area under the ROC curve (AUC) was calculated to assess reliability, and the differences between the AUC values were compared. Multivariate logistic regression analyses were performed to determine predictors affecting SCB attainment. Results: There were 76 patients enrolled in this study. The 12-month Lysholm, IKDC-SKF, Tegner, and ACL-RSI scores that corresponded to the SCB were 88.0, 85.1, 6.5, and 64.2 for anchor question 1 and 84.5, 77.7, 5.5, and 57.1 for anchor question 2, respectively. The AUC values obtained from the ROC curve analyses showed acceptable to excellent reliability (anchor question 1: Lysholm, 0.90; IKDC-SKF, 0.86; Tegner, 0.71; ACL-RSI, 0.92; anchor question 2: Lysholm, 0.80; IKDC-SKF, 0.90; Tegner, 0.82; ACL-RSI, 0.82) and were all statistically significant ( P < .001 to P = .028). For all PROs, younger age (Odds Ratio (OR), 0.88-0.94; P < .001 to P = .027) and greater muscle strength (OR, 1.03-1.07; P < .001 to P = .023) were predictive factors of SCB attainment. Conclusion: The postoperative Lysholm, IKDC-SKF, Tegner, and ACL-RSI scores showed acceptable to excellent reliability in predicting the SCB after ACLR in the general population. Age at surgery and thigh muscle strength influenced SCB attainment for all PROs.

Comparison of the PROMIS and iHOT-12 in Determining Satisfaction Levels After Hip Arthroscopy for FAIS

“…The AUC from ROC analysis defines the strength of association and the accuracy of the score in distinguishing between groups, with values ranging from 0.7 to 0.8 being acceptable and >0.8 to 0.9 being excellent. 16 , 21 In the present study, AUC values for the PROMIS-PF and iHOT-12 were similar and ranged between 0.73 and 0.82. The PROMIS-PI subscale had the lowest AUC values, ranging between 0.67 and 0.75.…”

Addition of anterolateral ligament reconstruction to primary anterior cruciate ligament reconstruction could benefit recovery of functional outcomes

“…Patient-reported outcomes included the Lysholm Knee Scoring Scale, Tegner Activity Scale, International Knee Documentation Committee (IKDC), and Tampa Scale for Kinesiophobia (TSK-11) scores 27 – 29 . The Lysholm Knee Scoring Scale consisted of eight items: limping, pain, support, swelling, restraining, instability, squatting, and stair climbing.…”

Management of ACL Reconstruction Complicated by MRSA Osteomyelitis Requiring a Gastrocnemius Perforator Flap

“…Compared with preoperative outcome metrics, she demonstrated improvements in the International Knee Documentation Committee (+51.7), Knee Injury and Osteoarthritis Outcome Score JR (+35.5), and Patient-Reported Outcomes Measurement Information System-Pain Interference (−14.6) at the 2-year follow-up, each of which exceeded threshold values for a mean clinically important difference and substantial clinical benefit (Table I). 8-10…”