Several factors predict the achievement of the patient acceptable symptom state and minimal clinically important difference for patient-reported outcome measures following anterior cruciate ligament reconstruction: A systematic review.

IF 3.3 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-09-09 DOI:10.1002/ksa.12460

Bryan Sun, Prushoth Vivekanantha, Hassaan Abdel Khalik, Darren de Sa

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Abstract

Purpose: 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).

Methods: 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.

Results: 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).

Conclusion: 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 of evidence: Level IV.

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前十字韧带重建术后患者可接受的症状状态和患者报告结果测量的最小临床重要差异有几个预测因素：系统综述。

目的：总结前交叉韧带重建（ACLR）术后患者可接受症状状态（PASS）、最小临床重要差异（MCID）和患者报告结果测量（PROMs）最小重要变化（MIC）的预测因素：方法：检索了从开始到 2024 年 1 月 5 日的 MEDLINE、PubMed 和 Embase。作者遵守了 PRISMA/R-AMSTAR 指南和 Cochrane 《干预措施系统综述手册》。提取了预测因素与 PROMs 之间的统计关联数据。适当时计算反向几率比（ORs）和置信区间（反向分组比较），以确保比较的一致性：共纳入 13 项研究，包括 21,235 名患者（48.1% 为女性）（平均年龄为 29.3 岁）。由 3857 名患者组成的 8 项研究确定了 PASS 的预测因素，包括外侧关节外腱鞘切除术 (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）和术前 PROMs 较高（OR 范围：1.04-1.21）。由 18,069 名患者组成的八项研究确定了 MCID 或 MIC 的负预测因素，包括女性性别（OR = 0.93，P = 0.034）、无 HT 自体移植物（OR = 0.70，P = 0.034）、术前 PROMs 较高（OR 范围：1.04-1.21）和术前 PROMs 较低（OR 范围：1.03-1.32）：较高的术前 PROMs、30 岁以上、男性、LETs 和 HT 自体移植物预示着 PASS 的实现。而较低的术前 PROMs、男性、非碰撞运动和未进行半月板切除术则预示着 MCID/MIC 成绩。本综述提供了对具有临床意义的 ACLR 术后结果预测因素的全面了解，从而改善了临床决策和患者期望管理：证据等级：IV 级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).