BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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确定原发性 ACL 重建后患者报告结果测量的最大结果改善阈值：一项使用 Anchor 方法的中期随访研究。


背景 前交叉韧带 （ACL） 重建 （ACLR） 后患者报告的结果测量 （PROM） 的临床解释可能具有挑战性。本研究旨在通过确定初次 ACLR 后中期随访中的最大结局改善 （MOI） 阈值来确定 PROMs 的临床相关性。方法 共纳入 343 例在我院行腘绳肌腱自体移植术的初次单束 ACLR 患者。询问患者 2 个选项的锚定问题，询问他们对当前膝关节症状状态的满意度。每位患者的 PROM 的 MOI 计算为改善百分比按最大可能改善进行标准化。根据受试者工作特征曲线分析，将每个 PROM 的 MOI 阈值确定为预测患者满意度的最佳临界值。进行多变量 logistic 回归分析以确定达到这些阈值的预测因子。进行亚组分析，对队列内从受伤到手术的时间进行分层，并在每个亚组内重新计算 MOI 阈值。本研究中评估的 PROM 是改良的 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。结果 计算出的 Lysholm 评分的 MOI 阈值为 35.1%，IKDC 评分为 46.7%。从受伤到手术的时间越长，达到 Lysholm 评分 （每个时间范围的比值比 [OR] = 0.7114，p < 0.0001） 和 IKDC 评分 （OR = 0.8038，p = 0.0003） 达到 MOI 阈值的几率降低。男性与达到 IKDC 评分 MOI 阈值的较高几率相关 （OR = 1.9645，p = 0.0143）。 对于慢性 ≤ 个月的患者，Lysholm 评分的 MOI 阈值为 35.1%，IKDC 评分的 MOI 阈值为 57.9%，对于慢性 >6 个月的患者，阈值分别为 24.5% 和 27.1%。结论 初次 ACLR 后中期随访时计算的 Lysholm 和 IKDC 评分的 MOI 阈值分别为 35.1% 和 46.7%。ACL 损伤的慢性性较高与中期随访时达到 PROM MOI 阈值的几率较低相关。证据级别 治疗 IV 级。有关证据级别的完整描述，请参阅作者说明。