Jeon Young-Sik, Lee Ja-Woon, Kim Soo-Hyun, Kim Sang-Gyun, Kim Young-Ha, Bae Ji Hoon
Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Armed Forces Capital Hospital, Seongnam, Republic of Korea.
Orthop J Sports Med. 2022 May 5;10(5):23259671221091795. doi: 10.1177/23259671221091795. eCollection 2022 May.
Little is known about the threshold of patient-reported outcomes (PROs) at which patients perceive to have attained a substantial clinical benefit (SCB) after anterior cruciate ligament reconstruction (ACLR).
To determine the SCB value of PROs 1 year after ACLR in the general population and to determine factors that predict SCB attainment.
Case series; Level of evidence, 4.
The Lysholm, International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF), Tegner, and Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scores were examined postoperatively in 88 patients who underwent ACLR. At the 12-month follow-up visit, the patients answered 2 independent anchor questions about daily discomfort and functional recovery. Receiver operating characteristic (ROC) curve analysis was used to differentiate PRO scores between patients who responded as having no difficulty versus some difficulty with daily knee discomfort (anchor question 1) and between patients with substantial recovery versus nonsubstantial recovery of knee function (anchor question 2). The area under the ROC curve (AUC) was calculated to assess reliability, and the differences between the AUC values were compared. Multivariate logistic regression analyses were performed to determine predictors affecting SCB attainment.
There were 76 patients enrolled in this study. The 12-month Lysholm, IKDC-SKF, Tegner, and ACL-RSI scores that corresponded to the SCB were 88.0, 85.1, 6.5, and 64.2 for anchor question 1 and 84.5, 77.7, 5.5, and 57.1 for anchor question 2, respectively. The AUC values obtained from the ROC curve analyses showed acceptable to excellent reliability (anchor question 1: Lysholm, 0.90; IKDC-SKF, 0.86; Tegner, 0.71; ACL-RSI, 0.92; anchor question 2: Lysholm, 0.80; IKDC-SKF, 0.90; Tegner, 0.82; ACL-RSI, 0.82) and were all statistically significant ( < .001 to = .028). For all PROs, younger age (Odds Ratio (OR), 0.88-0.94; < .001 to = .027) and greater muscle strength (OR, 1.03-1.07; < .001 to = .023) were predictive factors of SCB attainment.
The postoperative Lysholm, IKDC-SKF, Tegner, and ACL-RSI scores showed acceptable to excellent reliability in predicting the SCB after ACLR in the general population. Age at surgery and thigh muscle strength influenced SCB attainment for all PROs.
关于前交叉韧带重建（ACLR）后患者报告结局（PROs）达到实质性临床获益（SCB）的阈值，目前所知甚少。
确定一般人群ACLR术后1年PROs的SCB值，并确定预测达到SCB的因素。
病例系列；证据等级，4级。
对88例行ACLR的患者术后检查Lysholm、国际膝关节文献委员会主观膝关节评估表（IKDC-SKF）、Tegner和前交叉韧带损伤后恢复运动（ACL-RSI）评分。在12个月随访时，患者回答2个关于日常不适和功能恢复的独立锚定问题。采用受试者操作特征（ROC）曲线分析来区分在日常膝关节不适方面回答无困难与有困难的患者（锚定问题1）以及膝关节功能有实质性恢复与无实质性恢复的患者（锚定问题2）之间的PRO评分。计算ROC曲线下面积（AUC）以评估可靠性，并比较AUC值之间的差异。进行多变量逻辑回归分析以确定影响达到SCB的预测因素。
本研究纳入76例患者。与SCB相对应的12个月Lysholm、IKDC-SKF、Tegner和ACL-RSI评分，锚定问题1分别为88.0、85.1、6.5和64.2，锚定问题2分别为84.5、77.7、5.5和57.1。从ROC曲线分析获得的AUC值显示出可接受至极好的可靠性（锚定问题1：Lysholm，0.90；IKDC-SKF，0.86；Tegner，0.71；ACL-RSI，0.92；锚定问题2：Lysholm，0.80；IKDC-SKF，0.90；Tegner，0.82；ACL-RSI，0.82），且均具有统计学意义（P <.001至P =.028）。对于所有PROs，年龄较小（优势比（OR），0.88 - 0.94；P <.001至P =.027）和肌肉力量较强（OR，1.03 - 1.07；P <.001至P =.023）是达到SCB的预测因素。
术后Lysholm、IKDC-SKF、Tegner和ACL-RSI评分在预测一般人群ACLR后的SCB方面显示出可接受至极好的可靠性。手术时年龄和大腿肌肉力量影响所有PROs达到SCB的情况。
