Which Metrics Are Being Used to Evaluate Children and Adolescents After ACL Reconstruction? A Systematic Review

Abstract

Purpose To identify a comprehensive list of outcome measures previously used in the literature to evaluate clinical outcomes after reconstruction of the anterior cruciate ligament (ACL) in patients 18 years of age or younger. Methods A literature search was performed by querying MEDLINE, Embase and Cochrane computerized databases for relevant articles that reported clinical outcomes in pediatric patients undergoing ACL reconstruction. Studies that were nonclinical, that reported on patients older than 19 years, that were not available in English, or that included fewer than 10 patients were excluded. Outcome measures of all eligible studies were recorded. Results We identified 77 studies published between 1986 and 2018 in 20 peer-reviewed journals. The mean age of the patients was 13.9 years. The ACL rerupture rate was reported in 60% of studies; 32 studies (42%) reported a rate of return to preinjury activity or sports. The use of adult-validated patient-reported outcome measures were reported in 63 (82%) articles. The Lysholm (64%), International Knee Documentation Committee (IKDC) (56%) and Tegner (37%) scores were the most commonly reported. Two patient-reported outcome measures designed for pediatric patients (the Pedi-IKDC and Hospital for Special Surgery Pediatric Functional Activity Brief Scale (Pedi-FABS) were employed in 5 (6%) recent studies. Conclusions There is variability across studies in the metrics used to assess clinical outcomes following ACL reconstruction in children and adolescents. Validated pediatric-specific instruments were used infrequently. Clinical Relevance A large body of existing pediatric ACL-reconstruction literature relies on a variable set of outcome measures that have not been developed or validated for children and adolescents. More recently, contemporary studies have begun to employ pediatric- and adolescent-specific validated measures, yet their use remains uncommon.

Portuguese Cross-Cultural Adaptations of the Pediatric International Knee Documentation Committee Score

“…This survey has been extensively used in the literature, [11][12][13][14][15] and a recently published systematic review showed that Pedi-IKDC is the most studied PROM and has the best psychometric properties and, as such, should be preferred in detriment of other instruments. 12 The Pedi-IKDC was already validated in many other languages, [15][16][17] with the validation studies being conducted in pediatric populations affected by a broad spectrum of knee injuries and disorders. However, to date there were no knee-specific PROMS validated for the Portuguese-speaking pediatric population.…”

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

“…In adults, a weak to moderate correlations between functional tests (including strength tests) and the International Knee Documentation Committee (IKDC) questionnaire and Tegner score has been reported 6–9 months after ACL reconstruction [26]. It is unknown if these relations between outcomes exist in children with ACL injury, and only about 15% of studies on treatment of ACL injury in children include functional tests [27], 39], and generally there is no standard for how outcomes are best reported [11].…”

Unique Considerations for the Pediatric Athlete During Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction

“…87 Fabricant found the use of PROMs to evaluate pediatric ACLR is neither standardized nor validated for the population. 88 The Lysholm, International Knee Documentation Committee Subjective Knee form (IKDC), Tegner Activity Scale, and Knee Injury and Osteoarthritis Outcome Score (KOOS) are frequently reported PROMs in the pediatric ACL literature, 88,89 but none are designed for nor validated in the pediatric population. The use of adult PROMs in children has been shown to cause comprehensibility problems and should be avoided.…”