Psychological Patient-reported Outcomes Cannot Predict a Second Anterior Cruciate Ligament Injury in Patients who Return to Sports after an Anterior Cruciate Ligament Reconstruction

Ramana Piussi; Rebecca Simonson; Johan Högberg; Roland Thomeé; Kristian Samuelsson; Eric Hamrin Senorski

doi:10.26603/001c.55544

Psychological Patient-reported Outcomes Cannot Predict a Second Anterior Cruciate Ligament Injury in Patients who Return to Sports after an Anterior Cruciate Ligament Reconstruction

Int J Sports Phys Ther. 2022 Dec 1;17(7):1340-1350. doi: 10.26603/001c.55544. eCollection 2022.

Authors

Ramana Piussi^{1

2

3}, Rebecca Simonson^{1

3}, Johan Högberg^{1

2

3}, Roland Thomeé^{1

2}, Kristian Samuelsson^{3

4}, Eric Hamrin Senorski^{1

2

3

5}

Affiliations

¹ Sportrehab Sports Medicine Clinic, Gothenburg, Sweden.
² Unit of Physiotherapy, Department of Health and Rehabilitation Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³ Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.
⁴ Department of Orthopaedics Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁵ Swedish Olympic Committee (SOC), Stockholm, Sweden.

Abstract

Background: Psychological patient-reported outcomes (PROs) are recommended for use in test batteries to aid in decision-making, regarding whether patients are well prepared to return to sports (RTS) after anterior cruciate ligament (ACL) reconstruction. However, the values that should be regarded as "pass" or "fail" are still unclear.

Purpose: This study aimed to identify cut-off values for three commonly used psychological PROs that could differentiate patients who suffer a second ACL injury from patients who do not within two years of RTS in patients after ACL reconstruction with respect to recovery of symmetrical quadriceps strength.

Study design: Diagnostic/prognostic study.

Methods: Demographic data, isokinetic strength test data for quadriceps, as well as results for the ACL-Return to Sport after Injury scale (ACL-RSI), Knee Injury and Osteoarthritis Outcome Score (KOOS) Quality of Life, and Function in Sport and Recreation sub-scales, and the 18-item version of the Knee Self-Efficacy Scale (K-SES₁₈) were extracted from a registry. Receiver operating characteristic (ROC) curves were calculated for each PRO. Accuracy of the cut-offs was presented with two summary measures for the ROC: the area under the curve (AUC) and Youden index.

Results: In total, 641 (355 men, 61%) patients (24.8 [SD 7.6] year old at ACL reconstruction) were included. The cut-off values were not able to differentiate patients who suffered a second ACL injury up to 24 months after RTS and ACL reconstruction from patients who did not. Additionally, achieving symmetrical quadriceps strength did not improve the cut-off psychometric properties.

Conclusion: Since cut-off values could not differentiate between patients who suffered a second ACL injury and those who did not, clinicians should not rely only on cut-off values or a single PRO of those analyzed in this study when making decisions on which patients are at risk of experiencing a second ACL injury when returning to sports after ACL reconstruction.

Level of evidence: Level 3.

Keywords: anterior cruciate ligament; knee self efficacy scale; pateient reported outcomes; psychological outcomes; return to sport; return to sport after injury scale.