Proportion of patients reporting acceptable symptoms or treatment failure and their associated KOOS values at 6 to 24 months after anterior cruciate ligament reconstruction.
Ingelsrud LH, Granan L, Terwee CB, Engebretsen L, Roos EM. Am J Sports Med. 2015. 43 (8)
Take Home Message: Only 55 to 66% of patients who were 3 to 24 months post anterior cruciate ligament (ACL) reconstruction perceived their symptoms following treatment as acceptable.
Despite ACL reconstruction being a common surgical procedure, it is unclear how many patients after surgery perceive their symptoms as acceptable or as a failure of treatment. Furthermore, it would be helpful to know what scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS), a common patient-reported outcome measure, represent an acceptable or unacceptable outcome after surgery. Therefore, Ingelsrud and colleagues completed a cross-sectional study to assess the proportion of patients that perceive their symptoms post ACL reconstruction as either acceptable or failed. Furthermore, the authors evaluated the KOOS values that corresponded to acceptable or failed outcomes. The authors randomly extracted 1197 patients at 3 time periods (6 months, 12 months, and 24 months) post-surgery from the Norwegian Knee Ligament Registry. Five hundred ninety-eight patients received, completed, and returned the Norwegian version of the KOOS. These patients also answered questions regarding satisfaction, which were categorized as “acceptable symptoms,” “failed treatment”, or “undecided.” Overall, 55% of patients at the 6 month follow-up time period perceived their symptoms as acceptable while 68% and 65% had the same perception at the 12 and 24 month time point, respectively. Reported rates of perceived failure were 7, 11, and 13% at 6-, 12-, and 24-month time points, respectively. The average KOOS values ranged from 72 to 95 out of 100 for patients with acceptable symptoms while patients who reported failed treatments had KOOS values between 28 and 71. On average, individuals who were undecided about their outcome reported KOOS scores below the acceptable state.
Overall, the data presented should be a wakeup call to clinicians that a large percentage of patients do not consider their outcome after an ACL reconstruction as acceptable. On the plus side, more than half of patients who undergo an ACL reconstruction are pleased with their symptoms in the first 2 years after surgery. Furthermore, the KOOS, a free patient-reported outcome may help us identify patients who are not achieving an acceptable outcome. The KOOS results in the current study for “acceptable” and “failure” patients did not overlap. While not an objective of the study, this may suggest that KOOS parameters could help clinicians identify patients who perceive their ACL reconstruction as a success or failure. However, until more studies can be completed to validate this hypothesis, clinicians should use instruments like the KOOS to assess a patient’s symptoms post-surgery and be particularly aware to alter a treatment strategy when they notice a patient’s KOOS scores are not improving or are outside the range of “acceptable symptoms”.
Questions for Discussion: How do you assess patient outcomes following ACL reconstruction? Do you incorporate this assessment into your treatment plan and if so how?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
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Ingelsrud, L., Granan, L., Terwee, C., Engebretsen, L., & Roos, E. (2015). Proportion of Patients Reporting Acceptable Symptoms or Treatment Failure and Their Associated KOOS Values at 6 to 24 Months After Anterior Cruciate Ligament Reconstruction: A Study From the Norwegian Knee Ligament Registry The American Journal of Sports Medicine, 43 (8), 1902-1907 DOI: 10.1177/0363546515584041