No correlation between performance tests, clinical measurements and data from patient-reported outcome measures (PROM) in children reconstructed for anterior cruciate ligament injury

Warming, Susan; Herzog, Robert Bennike; Lundgaard-Nielsen, Mathilde; Rathcke, Martin Wyman; Krogsgaard, Michael

doi:10.1007/s00167-022-07174-1

Cited by 5 publications

(6 citation statements)

References 38 publications

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“…Therefore, one outcome is not representative for the condition, and the study hypothesis was rejected. The low correlations demonstrated in the current study are comparable to what has been found in children with ACL injury [ 33 ]. In a group of 75 athletes who were tested in relation to return to sport 9 months after ACLR there was a negligible correlation between limb symmetry index of single leg vertical jump height and IKDC score ( r = 0.26) [ 21 ].…”

Section: Discussionsupporting

confidence: 87%

“…One tested the correlation between the limb symmetry index for the one-leg vertical jump test against the subjective IKDC scores ( r = 0.26), Tegner score ( r = 0.64) and the ACL-RSI (Return to Sport after Injury) scale scores ( r = 0.61) nine months after ACLR in younger, adult male athletes [ 21 ]. The other found that in children who had an ACLR 1 year earlier there were no clinically important correlations between scores obtained by Pedi-IKDC and KOOS-Child, laxity measures, knee muscle strength and four functional performance tests [ 33 ].…”

Section: Introductionmentioning

confidence: 99%

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Functional performance tests, clinical measurements, and patient‐reported outcome measures do not correlate as outcomes 1 year after anterior cruciate ligament reconstruction

Al‐Gburi,

Kristiansen,

Christensen

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose The results after anterior cruciate ligament reconstruction (ACLR) are evaluated by laxity measures, functional tests, and patients’ perception by patient-reported outcome measures (PROMs). It is not known, if one of these evaluation instruments is representative or if outcome scores from all must be reported to obtain a full evaluation of the condition. The aim was to study the correlations between these three types of outcomes 1 year after primary ACLR. Method All adult patients (range 18–45 years) who had an ACLR between 1.1.2019 and 31.12.2021 were offered 1-year follow-up by an independent observer. Preoperative information about knee laxity and peroperative information about the condition of menisci and cartilage were registered. At 1-year follow-up clinical and instrumented knee stability and function assessed by four different hop tests were registered. Patients completed four PROMs (the Subjective International Knee Documentation Committee (IKDC) score, the Knee Numeric-Entity Evaluation Score (KNEES-ACL), the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Lysholm score) and Tegner activity scale and answered anchor questions regarding satisfaction and willingness to repeat the operation. Results A total of 190 adults attended the 1-year follow-up and 151 had all assessments. There were only a few positive and weak correlations between performance tests and PROMS and between clinical measurements and PROMS (r = 0.00–0.38), and the majority were of negligible strength. Tegner score had in general the highest correlation (low to moderate). The highest correlation was 0.53 (moderate) between the anchor question about patient satisfaction and Lysholm/IKDC scores. There was no difference in the correlations depending on meniscal condition. Conclusions In ACLR patients there was no clinically relevant correlation between scores obtained by PROMs, a battery of functional performance tests and instrumented laxity of the knee at 1-year follow-up. Therefore, one type of outcome cannot represent the others. This is an argument for always to include and report all three types of outcomes, and conclusions based on one type of outcome may not be sufficient. Level of evidence II.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Functional performance tests, clinical measurements, and patient‐reported outcome measures do not correlate as outcomes 1 year after anterior cruciate ligament reconstruction

Al‐Gburi,

Kristiansen,

Christensen

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…However, a previous study also did not find a correlation between patient-reported functional outcomes and objectively measured strength. 26 Therefore, isokinetic strength may not have been an appropriate choice to assess the convergent validity of a psychological assessment questionnaire such as the ACL-RSI, as these are likely measuring different Age at return-to-sport testing and body mass index (BMI) were analyzed using Spearman correlation, sex was analyzed using Mann Whitney U test, and race and ethnicity were analyzed using Kruskal-Wallis test (N = 51). ACL-RSI, Anterior Cruciate Ligament-Return to Sport after Injury; N/A, not applicable.…”

Section: Discussionmentioning

confidence: 99%

“…However, a previous study also did not find a correlation between patient-reported functional outcomes and objectively measured strength. 26 Therefore, isokinetic strength may not have been an appropriate choice to assess the convergent validity of a psychological assessment questionnaire such as the ACL-RSI, as these are likely measuring different constructs altogether. Range of motion may have been a better choice as another study of the ACL-RSI in a young population (18 athletes aged 20 ± 7.4 years) found that range of motion of the hip and knee correlated with ACL-RSI score, with knee frontal plane range of motion being the most significant factor.…”

Section: Discussionmentioning

confidence: 99%

Validation of the ACL-RSI Scale in Pediatric and Adolescent Patients

Cirrincione,

Gross,

Matsuzaki

et al. 2023

Am J Sports Med

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Background: The Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scale is a 12-item questionnaire assessing psychological readiness to return to sport after anterior cruciate ligament reconstruction. It has been validated for use in adults in multiple languages and in an abbreviated 6-question short form. Additionally, literature has been published using this scale in pediatric and adolescent populations, however it has not yet been validated for use with them. Purpose: To validate the ACL-RSI scale for use with pediatric and adolescent patients. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: Scores of 6- and 12-item ACL-RSI scales for patients undergoing return-to-sport readiness testing 6 to 8 months after anterior cruciate ligament reconstruction were analyzed. Convergent validity testing was performed against the International Knee Documentation Committee (IKDC)/Pediatric IKDC score, Single Assessment Numeric Evaluation (SANE) score, and peak torque asymmetry of knee flexion and extension using Spearman correlations. Discriminant validity testing was performed against age (Spearman correlation), body mass index (Spearman correlation), and sex (Mann-Whitney U test). Reliability testing was performed by calculating Cronbach’s alpha. Floor and ceiling effects were assessed by calculating the number of minimum and maximum scores in the cohort. Results: A total of 51 patients were included in the final analysis. The mean age at surgery was 15.2 ± 2.2 years, and 51.0% were female. The 6- and 12-item ACL-RSI scales demonstrated a strong significant positive correlation with IKDC/Pediatric IKDC scores ( R = 0.723 and 0.717, respectively; P < .001) and moderate significant positive correlation with Single Assessment Numeric Evaluation scores ( R = 0.516 and 0.502, respectively; P < .001) Age at surgery, body mass index, and sex were not correlated with either ACL-RSI scale. Cronbach’s alpha values of the 12- and 6-item ACL-RSI scales in this population were 0.959 and 0.897, respectively. For both the 12- and the 6-item ACL-RSI scales, no floor or ceiling effects were found as the minimum score (0) was not observed in either version, and the maximum score (100) was only observed twice (3.9%) in both versions. Conclusion: The ACL-RSI scale is valid to use with pediatric and adolescent patients. The 6-item scale may be a better choice because it has fewer redundancies and minimizes the risk of questionnaire fatigue.

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“…A significant factor for this is an increased participation in sports among children, compared to earlier. Additionally, there has been a tendency towards early specialisation and intensified sports training at an early age [14,26,31,38,45,46,48].…”

Section: Introductionmentioning

confidence: 99%

Good physical function but reduced quality of life in children 3 years after ACL reconstruction

Lundgaard‐Nielsen,

Herzog,

Warming

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo assess children's physical function and subjective knee status 1 and 3 years after anterior cruciate ligament (ACL) reconstruction. It was hypothesised that there was no difference between the operated and normal legs in relation to physical strength and function, that there was <‐2 mm side‐to‐side difference in knee laxity, and that the subjective knee function was better 3 years after ACL reconstruction compared to 1 year after.MethodsChildren (<16 years of age) who had an ACL reconstruction had follow‐up with physical function tests (four hop tests and strength measurement in a power rig [PR]), anterior knee laxity (measured using a Rolimeter) and patient‐reported outcome measures (Pedi‐International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]‐Child) 1 and 3 years postoperatively. Changes from 1‐ to 3‐year follow‐up were evaluated with a paired t test.ResultsOut of 148 ACL reconstructed children, 60 had all measures. The four hop tests and the PR all yielded a Limb Symmetry Index >90% at both follow‐ups. There was a significant improvement from 1‐ to 3‐year follow‐up in two‐hop tests (6 m on time and crossover hop). Side‐to‐side knee laxity was >2 mm in four children at 1‐ and 3‐year tests. Pedi‐IKDC scores increased, and KOOS‐Child improved significantly from 1 to 3 years in two of the five domains: ‘Sport’ and ‘Quality of life’, but scores were lower than in a cohort of normal children.ConclusionThe children had good objective physical function 1 and 3 years after ACL reconstruction. However, scores from the KOOS‐Child sport‐specific function and quality of life domains were lower than in normal children.Level of evidenceLevel II.

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No correlation between performance tests, clinical measurements and data from patient-reported outcome measures (PROM) in children reconstructed for anterior cruciate ligament injury

Cited by 5 publications

References 38 publications

Functional performance tests, clinical measurements, and patient‐reported outcome measures do not correlate as outcomes 1 year after anterior cruciate ligament reconstruction

Functional performance tests, clinical measurements, and patient‐reported outcome measures do not correlate as outcomes 1 year after anterior cruciate ligament reconstruction

Validation of the ACL-RSI Scale in Pediatric and Adolescent Patients

Good physical function but reduced quality of life in children 3 years after ACL reconstruction

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