Chen Raymond E, Papuga M Owen, Voloshin Ilya, Nicandri Gregg T, Goldblatt John P, Bronstein Robert D, Rouse Lucien M, Maloney Michael D
Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York, USA.
Orthop J Sports Med. 2018 May 8;6(5):2325967118771286. doi: 10.1177/2325967118771286. eCollection 2018 May.
PROMIS (Patient-Reported Outcomes Measurement Information System) scores in patients undergoing anterior cruciate ligament (ACL) reconstruction have not been fully described in the literature to date. The ability of preoperative patient-reported outcome scores to directly predict postoperative outcomes in patients who undergo primary ACL reconstruction is unknown.
Postoperative PROMIS physical function (PF), pain interference (PI), and depression (D) scores in patients who undergo ACL reconstruction will show improvement when compared with preoperative scores. Additionally, preoperative PROMIS PF, PI, and D scores will predict which patients will not achieve a minimal clinically important difference (MCID) postoperatively.
Cohort study; Level of evidence, 3.
A total of 233 patients who underwent primary ACL reconstruction between 2015 and 2016 and had completed PROMIS measures both preoperatively (within 60 days of surgery) and postoperatively (100-240 days after surgery) were included in this study. PROMIS PF, PI, and D scores were compared. Accuracy analyses were performed to determine whether preoperative PROMIS scores from each domain could predict postoperative achievement of MCID in the same domain. Cutoff scores were then calculated.
PROMIS PF, PI, and D scores all showed a significant improvement after ACL reconstruction (all < .001). Preoperative scores from all 3 PROMIS domains showed a strong ability to predict clinically meaningful improvement, as defined by MCID, with areas under the receiver operating characteristic curve from 0.72 to 0.84. Optimal cutoffs for preoperative PROMIS scores showed that patients with a PF score of <42.5, PI score of >56.2, or D score of >44.8 were more likely to achieve MCID.
PROMIS PF, PI, and D scores improved significantly in patients who underwent primary ACL reconstruction. Preoperative PROMIS PF, PI, and D scores were highly predictive of outcome in the early postoperative period. The reported cutoff scores showed high probability in predicting which patients would and would not achieve a clinically meaningful improvement.
目前文献中尚未充分描述前交叉韧带（ACL）重建患者的PROMIS（患者报告结局测量信息系统）评分情况。术前患者报告的结局评分能否直接预测初次ACL重建患者的术后结局尚不清楚。
ACL重建患者术后的PROMIS身体功能（PF）、疼痛干扰（PI）和抑郁（D）评分与术前评分相比将有所改善。此外，术前PROMIS PF、PI和D评分将预测哪些患者术后无法达到最小临床重要差异（MCID）。
队列研究；证据等级，3级。
本研究纳入了2015年至2016年间接受初次ACL重建且术前（手术60天内）和术后（术后100 - 240天）均完成PROMIS测量的233例患者。比较了PROMIS PF、PI和D评分。进行准确性分析以确定每个领域的术前PROMIS评分是否能够预测同一领域术后MCID的达成情况。然后计算截断分数。
ACL重建后PROMIS PF、PI和D评分均有显著改善（均P <.001）。所有3个PROMIS领域的术前评分均显示出较强的预测临床有意义改善的能力，以MCID定义，受试者工作特征曲线下面积为0.72至0.84。术前PROMIS评分的最佳截断值显示，PF评分<42.5、PI评分>56.2或D评分>44.8的患者更有可能达到MCID。
接受初次ACL重建的患者，其PROMIS PF、PI和D评分显著改善。术前PROMIS PF、PI和D评分对术后早期结局具有高度预测性。报告的截断分数在预测哪些患者会以及不会实现临床有意义的改善方面具有较高的概率。
