Zebis Mette K, Warming Susan, Pedersen Maria B, Kraft Marie H, Magnusson S Peter, Rathcke Martin, Krogsgaard Michael, Døssing Simon, Alkjær Tine
Department of Physiotherapy, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark.
Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
Orthop J Sports Med. 2019 Jul 30;7(7):2325967119861803. doi: 10.1177/2325967119861803. eCollection 2019 Jul.
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.
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.
Systematic review; Level of evidence, 4.
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.
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).
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.
儿童前交叉韧带（ACL）损伤的发生率正在上升。然而，目前尚无用于评估小儿ACL损伤的标准化核心结局指标集。
对文献进行范围综述，以确定用于评估小儿ACL损伤患者的患者报告结局指标（PROMs）和客观结局指标，并根据国际功能、残疾和健康分类（ICF）领域对这些指标进行分类。
系统综述；证据级别，4级。
通过PubMed、EMBASE、CINAHL和PEDro数据库对文献进行系统检索。纳入标准为丹麦语、挪威语、瑞典语、德语或英语；2010年至2018年发表；小儿ACL损伤（年龄≤15岁的患者）；以及结局指标。根据预先定义的纳入和排除标准，对所选论文进行标题、摘要和全文筛选。
共纳入68篇论文（4286例患者；平均年龄±标准差，12.2±2.3岁）。确定了19项PROMs和11项客观结局指标。最常报告的PROMs是国际膝关节文献委员会（IKDC）主观膝关节表格（51%的研究）、Lysholm评分量表（46%的研究）和Tegner活动评分量表（37%的研究）。此外，41%的研究报告了恢复运动情况。最常见的客观指标是膝关节松弛度（76%的研究）、生长发育障碍（69%的研究）、活动范围（41%的研究）和肌肉力量（21%的研究）。关于ICF领域，IKDC涵盖了所有3个ICF健康领域，Lysholm评分涵盖了身体结构与功能以及活动受限领域，而Tegner评分涵盖了参与限制领域。客观测量的膝关节松弛度、活动范围和肌肉力量涵盖1个领域（身体结构与功能）。
小儿ACL损伤患者主要通过IKDC进行主观评估，通过膝关节松弛度进行客观评估。ACL损伤后儿童的评估尚无共识。大多数应用的结局指标是为成人开发的。为了涵盖ICF健康领域，未来的研究需要考虑与小儿ACL损伤患者相关的可靠且有效的结局指标。
