Outcome Measures After ACL Injury in Pediatric Patients: A Scoping Review

Abstract

Background:The incidence of anterior cruciate ligament (ACL) injuries in children is increasing. However, no standardized core set of outcome measures exists for evaluating pediatric ACL injuries.Purpose:To perform a scoping review of the literature to identify patient-reported outcome measures (PROMs) and objective outcome measures used to evaluate pediatric patients after ACL injury and to classify these in accordance with the International Classification of Functioning, Disability, and Health (ICF) domains.Study Design:Systematic review; Level of evidence, 4.Methods:The literature was systematically searched with the PubMed, EMBASE, CINAHL, and PEDro databases. The inclusion criteria were Danish, Norwegian, Swedish, German, or English language; publication between 2010 and 2018; pediatric ACL injury (patients ≤15 years old); and outcome measures. The selected papers were screened for title, abstract, and full text in accordance with predefined inclusion and exclusion criteria.Results:A total of 68 papers (4286 patients; mean ± SD age, 12.2 ± 2.3 years) were included. Nineteen PROMs and 11 objective outcome measures were identified. The most frequently reported PROMs were the International Knee Documentation Committee (IKDC) Subjective Knee Form (51% of studies), Lysholm scoring scale (46% of studies) and Tegner activity rating scale (37% of studies). Additionally, return to sport was reported in 41% of studies. The most frequent objective measures were knee laxity (76% of studies), growth disturbances (69% of studies), range of motion (41% of studies), and muscle strength (21% of studies). With respect to the ICF domains, the IKDC covered all 3 ICF health domains, the Lysholm score covered the Body Structure and Function and the Activity Limitation domains, while the Tegner score covered the Participation Restriction domain. Objectively measured knee joint laxity, range of motion, and muscle strength covered 1 domain (Body Structure and Function).Conclusion:Pediatric patients with ACL injury were mainly evaluated subjectively with the IKDC and objectively by knee joint laxity. No consensus exists in the evaluation of children after ACL injury. The majority of applied outcome measures are developed for adults. To cover the ICF health domains, future research needs to consider reliable and valid outcome measures relevant for pediatric patients with ACL injury.

Reference data for hop tests used in pediatric ACL injury rehabilitation: A cross‐sectional study of healthy children

“…It is, however, important to emphasize that in clinical practice, hop tests and LSI do not stand alone. Outcome measures such as knee laxity, range of motion (ROM), muscle strength and patient‐reported outcome measures (PROMs) also form an important part of the evaluation and decision‐making for RTS 4 …”

“…Outcome measures such as knee laxity, range of motion (ROM), muscle strength and patient‐reported outcome measures (PROMs) also form an important part of the evaluation and decision‐making for RTS. 4 …”

Translation and transcultural validation of the Dutch Hospital for Special Surgery Paediatric Activity Brief Scale (HSS Pedi-FABS)

“…[17] Although the Tegner activity scale is not validated in the paediatric population, it is often used as an activity scale for children and adolescents. [18] The Tegner activity scale is a 1-item activity scale ranging from 0 (no activity) to 10 (high activity) and is widely used as an activity rating system for a variety of knee disorders. [19,20] Readability Readability of the Dutch HSS Pedi-FABS was assessed with the Dutch version of the Flesch reading ease (FRE) test.…”

Outcome measures used in intervention studies for the rehabilitation of mid‐portion achilles tendinopathy; a scoping review

“…A degree of consensus among Practitioners is necessary for deciding which are the most effective and appropriate measures to use. Otherwise, inconsistent or non‐standardized reporting of outcome measures erodes the possibility of inter‐study comparisons 8 . Substantial difficulty faces the clinician regarding the best choice of outcome measures when treating mid‐portion AT.…”

“…Otherwise, inconsistent or non-standardized reporting of outcome measures erodes the possibility of inter-study comparisons. 8 Substantial difficulty faces the clinician regarding the best choice of outcome measures when treating mid-portion AT. The most recent 2018 Clinical Guidelines certainly offer immense value as certain outcome measures are advocated by experts in the field of AT management and rehabilitation, 9 however, the range of choice within the Guidelines is expansive, indicating the decision ultimately resides with Clinician in the selection process.…”