Sun Bryan, Vivekanantha Prushoth, Khalik Hassaan Abdel, de Sa Darren
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Knee Surg Sports Traumatol Arthrosc. 2025 May;33(5):1617-1632. doi: 10.1002/ksa.12460. Epub 2024 Sep 9.
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).
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.
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).
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 IV.
总结前交叉韧带重建（ACLR）后患者报告结局指标（PROMs）的患者可接受症状状态（PASS）、最小临床重要差异（MCID）和最小重要变化（MIC）的预测因素。
检索MEDLINE、PubMed和Embase数据库，检索时间从建库至2024年1月5日。作者遵循PRISMA/R-AMSTAR指南以及《Cochrane干预措施系统评价手册》。提取预测因素与PROMs之间的统计学关联数据。在适当情况下计算逆比值比（ORs）和置信区间（反向组比较），以确保比较的一致性。
纳入13项研究，共21235例患者（女性占48.1%）（平均年龄29.3岁）。8项研究共3857例患者确定了PASS的预测因素，包括外侧关节外肌腱固定术（LET）（OR = 11.08，p = 0.01）、腘绳肌腱（HT）自体移植（OR范围：2.02 - 2.63，p≤0.011）、30岁以上（OR范围：1.37 - 2.28，p≤0.02）、男性（OR范围：1.03 - 1.32，p≤0.01）以及术前较高的PROMs（OR范围：1.04 - 1.21）。8项研究共18069例患者确定了MCID或MIC的负向预测因素，包括女性（OR = 0.93，p = 0.034）、无HT自体移植（OR = 0.70，p < 0.0001）、术前较高的PROMs（OR = 0.76 - 0.84，p≤0.01）、半月板切除术（OR = 0.67，p = 0.014）以及从事对抗性运动（OR = 0.02 - 0.60，p≤0.05）。
术前较高的PROMs、30岁以上、男性、LET和HT自体移植可预测达到PASS。术前较低的PROMs、男性、非对抗性运动以及未行半月板切除术可预测达到MCID/MIC。本综述全面了解了ACLR后具有临床意义的结局的预测因素，从而改善临床决策和患者预期管理。
四级。
