Zhang Zhi-Yu, Shi Wei-Li, Bai Wen-Bin, Hong Le-Jin, Dai Wen-Li, Pan Xiao-Yu, Fu Xiao-Yue, Wang Jian-Quan, Wang Cheng
Department of Sports Medicine, Peking University Third Hospital, Beijing, People's Republic of China.
Institute of Sports Medicine of Peking University, Beijing, People's Republic of China.
J Bone Joint Surg Am. 2025 Jan 15;107(2):e4. doi: 10.2106/JBJS.23.01330. Epub 2024 Nov 6.
The clinical interpretation of patient-reported outcome measures (PROMs) after anterior cruciate ligament (ACL) reconstruction (ACLR) can be challenging. This study aimed to establish the clinical relevance of PROMs by determining maximal outcome improvement (MOI) thresholds at mid-term follow-up after primary ACLR.
A total of 343 patients who underwent primary single-bundle ACLR using hamstring tendon autograft at our institute were included. Patients were queried with a 2-option anchor question regarding satisfaction with their current knee symptom state. The MOI of a PROM was calculated for each patient as the percentage of improvement normalized by the maximal possible improvement. The MOI threshold for each PROM was determined as the optimal cutoff value for predicting patient satisfaction based on receiver operating characteristic curve analysis. Multivariable logistic regression analyses were performed to identify predictors of achieving these thresholds. Subgroup analyses that stratified the time from injury to surgery within the cohort were performed, and MOI thresholds were recalculated within each of these subgroups. The PROMs evaluated in this study were the modified Lysholm Knee Score and the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) score.
The calculated MOI threshold was 35.1% for the Lysholm score and 46.7% for the IKDC score. A longer time from injury to surgery reduced the odds of achieving the MOI threshold for the Lysholm score (odds ratio [OR] per time bracket = 0.7114, p < 0.0001) and IKDC score (OR = 0.8038, p = 0.0003). Male sex was associated with higher odds of achieving the MOI threshold for the IKDC score (OR = 1.9645, p = 0.0143). For patients with chronicity of ≤6 months, the MOI threshold was 35.1% for the Lysholm score and 57.9% for the IKDC score, and for patients with chronicity of >6 months, the thresholds were 24.5% and 27.1%, respectively.
The calculated MOI thresholds for the Lysholm and IKDC scores at mid-term follow-up after primary ACLR were 35.1% and 46.7%, respectively. Greater chronicity of the ACL injury was associated with lower odds of achieving the MOI thresholds for the PROMs at mid-term follow-up.
Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
前交叉韧带（ACL）重建（ACLR）后患者报告结局测量（PROMs）的临床解读具有挑战性。本研究旨在通过确定初次ACLR中期随访时的最大结局改善（MOI）阈值来确立PROMs的临床相关性。
纳入在我院接受自体腘绳肌腱单束初次ACLR的343例患者。就患者对当前膝关节症状状态的满意度询问一个有两个选项的锚定问题。为每位患者计算PROM的MOI，即改善百分比除以最大可能改善值进行标准化。根据受试者工作特征曲线分析，确定每个PROM的MOI阈值作为预测患者满意度的最佳截断值。进行多变量逻辑回归分析以确定达到这些阈值的预测因素。对队列中受伤至手术时间进行分层的亚组分析，并在每个亚组内重新计算MOI阈值。本研究评估的PROMs为改良Lysholm膝关节评分和国际膝关节文献委员会主观膝关节评估表（IKDC）评分。
Lysholm评分的计算MOI阈值为35.1%，IKDC评分为46.7%。受伤至手术时间越长，达到Lysholm评分MOI阈值的几率越低（每个时间区间的优势比[OR]=0.7114，p<0.0001），IKDC评分也是如此（OR=0.8038，p=0.0003）。男性达到IKDC评分MOI阈值的几率更高（OR=1.9645，p=0.0143）。对于病程≤6个月的患者，Lysholm评分的MOI阈值为35.1%，IKDC评分为57.9%；对于病程>6个月的患者，阈值分别为24.5%和27.1%。
初次ACLR中期随访时，Lysholm和IKDC评分的计算MOI阈值分别为35.1%和46.7%。ACL损伤的病程越长，中期随访时达到PROMs的MOI阈值的几率越低。
治疗性四级。有关证据水平的完整描述，请参阅作者指南。
