Lysholm and KOOS QoL Demonstrate High Responsiveness in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Several factors predict the achievement of the patient acceptable symptom state and minimal clinically important difference for patient-reported outcome measures following anterior cruciate ligament reconstruction: A systematic review

PURPOSE

To summarize the predictors of the patient acceptable symptom state (PASS), minimal clinically important difference (MCID) and minimal important change (MIC) for patient-reported outcome measures (PROMs) following anterior cruciate ligament reconstruction (ACLR).

METHODS

MEDLINE, PubMed and Embase were searched from inception to 5 January 2024. The authors adhered to PRISMA/R-AMSTAR guidelines, and the Cochrane Handbook for Systematic Reviews of Interventions. Data on statistical associations between predictive factors and PROMs were extracted. Inverse odds ratios (ORs) and confidence intervals (reverse group comparison) were calculated when appropriate to ensure comparative consistency.

RESULTS

Thirteen studies comprising 21,235 patients (48.1% female) were included (mean age 29.3 years). Eight studies comprising 3857 patients identified predictors of PASS, including lateral extra-articular tenodesis (LET) (OR = 11.08, p = 0.01), hamstring tendon (HT) autografts (OR range: 2.02-2.63, p ≤ 0.011), age over 30 (OR range: 1.37-2.28, p ≤ 0.02), male sex (OR range: 1.03-1.32, p ≤ 0.01) and higher pre-operative PROMs (OR range: 1.04-1.21). Eight studies comprising 18,069 patients identified negative predictors of MCID or MIC, including female sex (OR = 0.93, p = 0.034), absence of HT autografts (OR = 0.70, p < 0.0001), higher pre-operative PROMs (OR = 0.76-0.84, p ≤ 0.01), meniscectomy (OR = 0.67, p = 0.014) and collision sports (OR = 0.02-0.60, p ≤ 0.05).

CONCLUSION

Higher pre-operative PROMs, age over 30, male sex, LETs and HT autografts predicted PASS achievement. Lower pre-operative PROMs, male sex, non-collision sports, and lack of meniscectomies predicted MCID/MIC achievement. This review provides a comprehensive understanding of the predictors of clinically significant post-ACLR outcomes, thus improving clinical decision-making and the management of patient expectations.

LEVEL OF EVIDENCE

Level IV.

Anterior Cruciate Ligament Reconstruction Augmentation With Bone Marrow Aspirate Concentrate, Demineralized Bone Matrix, and Suture Tape Shows No Difference in Outcomes-But Faster Functional Recovery-Versus Non-augmented Anterior Cruciate Ligament Reconstruction

PURPOSE

To compare outcomes after anterior cruciate ligament reconstruction (ACLR) with bone marrow aspirate concentrate (BMAC), demineralized bone matrix (DBM), and suture tape augmentation (STA) versus ACLR without biological augmentation or STA.

METHODS

We performed a prospective randomized controlled trial at a single institution to compare ACLR with BMAC, DBM, and STA (group A) versus ACLR without biological augmentation or STA (group NA). The study sought to include 100 patients. Skeletally mature patients younger than 25 years received quadriceps tendon autograft, whereas patients aged 25 years or older underwent allograft ACLR with an all-inside technique. Patients with concomitant meniscal pathologies were included. The primary outcomes compared were range of motion (ROM), limb symmetry, and patient-reported outcomes. Secondary outcomes included radiographic outcomes and surgical complications. Univariate and mixed-model regression analyses were used to compare outcomes.

RESULTS

Fifty-nine patients were included (29 patients in group A [11 female patients, 38%] and 30 patients in group NA [15 female patients, 50%]). Early ROM at 6 weeks (125° of flexion vs 109° of flexion, P < .0001) and limb symmetry at 12 weeks (80.6% vs 36.7% [delta, 43.9%], P < .001) were significantly improved in group A. At 2 years, International Knee Documentation Committee scores were similar (91.1 ± 12.7 vs 85.3 ± 10.8, P = .109). Quality-of-life subscores of the Knee Injury and Osteoarthritis Outcome Score were significantly enhanced in group A (85.2 ± 20.9 vs 72.1 ± 20.4, P = .042). In 22 patients (12 in group A and 10 in group NA), computed tomography scans were obtained at 6 months to compare bone tunnel healing. Overall, the mean increase in bone tunnel diameter was significantly smaller in group A than in group NA. No difference in graft rerupture or reoperation rate was observed. Reoperations were performed for stiffness in 7 of 59 patients (11.9%) (3 [10%] in group A vs 4 [13%] in group NA; P > .999).

CONCLUSIONS

There were no differences in International Knee Documentation Committee scores between groups at 2-year follow-up. Functional outcomes including early ROM and limb symmetry were significantly improved in patients who received ACLR with BMAC, DBM, and STA.

LEVEL OF EVIDENCE

Level II, randomized controlled trial.

Optimizing return-to-work decisions following anterior cruciate ligament reconstruction: A 12-week evaluation of objective functional assessment and rehabilitation outcomes in patients with occupational injuries

BACKGROUND

Anterior cruciate ligament (ACL) injuries are common, yet there is a critical knowledge gap regarding rehabilitation in non-athlete occupational populations. This lack of research translates to insufficient objective criteria to guide effective clinical decision-making in these patients. This research aimed to assess the impact of a 12-week rehabilitation program with specialized tools on the recovery and return-to-work potential of patients with occupational ACL injuries.

METHODS

A prospective, observational single-center study evaluated rehabilitation outcomes in patients after ACL reconstruction. Twenty patients undergoing ACL reconstruction participated in a 12-week clinical-functional follow-up program. Rehabilitation treatment was assessed through biomechanical gait analysis (dynamometric platform and NedAMH/IBV® software), isokinetic dynamometry ((Biodex 3™), and the Lysholm scale to assess patient-reported function. Statistical analysis included normality testing (Kolmogorov-Smirnov and Shapiro-Wilk tests) and appropriate tests for parametric (one-way ANOVA with repeated measures) or non-parametric data (Friedman test with Wilcoxon signed-rank post-hoc tests).

FINDINGS

Rehabilitation improved gait mechanics (reduced stance time, improved ground reaction forces by the ninth week) and muscle strength (decreased deficit, improved peak torque by 8th-12th week) as measured by biomechanical analysis and isokinetic dynamometry. Patient-reported function (Lysholm scale) also showed significant improvements from the sixth week onwards.

INTERPRETATION

Our findings indicate that rehabilitation following ACL reconstruction significantly enhances patient function in work-related injuries, as demonstrated by improvements in gait, strength, and self-reported outcomes. These objective assessments play a significant role in facilitating safe return-to-work decisions. Further research is necessary to explore job-specific rehabilitation strategies.

Does proprioceptive training improve joint function and psychological readiness in patients after anterior cruciate ligament reconstruction? A randomized controlled trial

INTRODUCTION

A decrease in proprioceptive sensation occurs after anterior cruciate ligament reconstruction (ACLR). However, there is relatively little research on proprioceptive rehabilitation, compared with studies on muscle strength and range of motion (ROM). The purpose of this study was to assess the effect of supplementing a traditional rehabilitation program with proprioceptive training in ACLR patients to improve knee function, psychological readiness, pain and dynamic balance in the early postoperative period.

METHODS

This was a randomized, parallel-group, controlled trial in which 48 patients were enrolled in either proprioceptive group (n = 24) or control group (n = 24) from the first week up to 12 th weeks of the operation. Participants in the control group received a traditional ACLR rehabilitation program, while the proprioceptive group received additional proprioceptive training in addition to the traditional ACLR rehabilitation program. The outcome measures included the International Knee Documentation Committee (IKDC), the ACL Return to Sport After Injury scale (ACL-RSI), the visual analog scale (VAS), and the Y-Balance Test before and after surgery.

RESULTS

We found that, at 12 weeks post-surgery, patients in the proprioceptive group had significantly higher IKDC scores compared to those in the control group (74.8 ± 4.3 vs 71.6 ± 5.2, P = 0.04). At the 12 th week, the ACL-RSI score of patients in the proprioceptive group was greater than that of the control group (68.2 ± 9.2 vs 62.8 ± 8.2, P = 0.04). The Y balance comprehensive index (YBCI) in the proprioceptive group of patients was greater than that in the control group (94.5% ± 3.3% vs 91.5% ± 4.1%, P = 0.01) at 12 weeks after surgery. No statistically significant differences in the VAS score were found between the two groups.

CONCLUSIONS

Proprioceptive training is superior to conventional training in terms of knee function, psychological readiness and dynamic balance 12 weeks after ACL reconstruction surgery, but has no statistically significant effect on pain.

TRIAL REGISTRATION

(Chinese Clinical Trial Registry ( https://www.chictr.org.cn ), No. ChiCTR2400087631, 7/31/2024).

Patients' joint perception after anterior cruciate ligament reconstruction as a reliable patient-reported outcome measure

PURPOSE

This study aims to evaluate and compare patients' joint perception (PJP) with other commonly employed patient-reported outcome measures (PROMs) in a cohort of patients following anterior cruciate ligament reconstruction (ACLR).

METHODS

A retrospective study was conducted on 108 patients who underwent ACLR between 2017 and 2021, with complete data available for visual analogue scale (VAS) pain, PJP, Forgotten Joint Score (FJS), Tegner Activity Scale, Lysholm Knee Scoring Scale, Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI), Single Assessment Numeric Evaluation (SANE), Cincinnati Knee Rating System (CKRS) and The Hospital for Special Surgery Anterior Cruciate Ligament Satisfaction Survey (HSS ACL-SS) at a mean follow-up of 3 years. Spearman's rank-order correlation was used to determine the correlations between clinical scores. A receiver operating characteristic (ROC) curve analysis was used to assess the discriminatory power of the chosen PROMs in detecting natural joint perception. Natural joint perception was defined as patients responding 'like a native or natural joint' or PJP = 1. This study hypothesized that PJP would demonstrate significant correlations with established PROMs, indicating its reliability and validity as a tool for assessing outcomes following ACLR.

RESULTS

PJP showed significant correlations with all the reported PROMs, suggesting its potential as a valid and reliable assessment tool for evaluating ACLR outcomes. The ROC curve analysis indicated a good area under the curve for identifying natural joint perception using various PROMs. According to the PJP, nearly 20% of patients reported natural joint perception.

CONCLUSION

This study evaluates PJP as a reliable tool for assessing patient outcomes following ACLR. Its significant correlation with other established PROMs underscores its potential as a valuable addition to the existing array of PROMs in ACLR.

LEVEL OF EVIDENCE

Level III.