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. 2022 Dec;56(24):1432-1444.
doi: 10.1136/bjsports-2022-105497. Epub 2022 Aug 16.

Meaningful thresholds for patient-reported outcomes following interventions for anterior cruciate ligament tear or traumatic meniscus injury: a systematic review for the OPTIKNEE consensus

Erin M Macri  1   2   3 , James J Young  4   5 , Lina Holm Ingelsrud  6 , Karim M Khan  3   7 , Berend Terluin  8 , Carsten Bogh Juhl  4   9 , Jackie L Whittaker  10   11 , Adam G Culvenor  12 , Kay M Crossley  13 , Ewa M Roos  4
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Meaningful thresholds for patient-reported outcomes following interventions for anterior cruciate ligament tear or traumatic meniscus injury: a systematic review for the OPTIKNEE consensus

Erin M Macri et al. Br J Sports Med. 2022 Dec.

Abstract

Objective: We synthesised and assessed credibility (ie, trustworthiness) of thresholds that define meaningful scores for patient-reported outcome measures (PROMs) following interventions for anterior cruciate ligament (ACL) tear or traumatic meniscus injury.

Design: Systematic review, narrative synthesis.

Data sources: We searched five databases, handsearched references of included studies and tracked citations.

Eligibility: Included studies investigated: individuals with ACL tear or meniscus injury; mean age <35 years; and PROM thresholds calculated using any method to define a minimal important change (MIC) or a meaningful post-treatment score (Patient Acceptable Symptom State (PASS) or Treatment Failure).

Results: We included 18 studies (15 ACL, 3 meniscus). Three different methods were used to calculate anchor-based MICs across 9 PROMs, PASS thresholds across 4 PROMs and treatment failure for 1 PROM. Credibility was rated 'high' for only one study-an MIC of 18 for the Knee injury and Osteoarthritis Outcome Score Quality-of-life (KOOS-QOL) subscale (using the MID Credibility Assessment Tool). Where multiple thresholds were calculated among 'low' credibility thresholds in ACL studies, MICs converged to within a 10-point range for KOOS-Symptoms (-1.2 to 5.4) and function in daily living (activities of daily living, ADL 0.5-8.1) subscales, and the International Knee Documentation Committee Subjective Knee Form (7.1-16.2). Other PROM thresholds differed up to 30 points. PASS thresholds converged to within a 10-point range in KOOS-ADL for ACL tears (92.3-100), and KOOS-Symptoms (73-78) and KOOS-QOL (53-57) in meniscus injuries.

Conclusion: Meaningful PROM thresholds were highly susceptible to study heterogeneity. While PROM thresholds can aid interpretability in research and clinical practice, they should be cautiously interpreted.

Keywords: anterior cruciate ligament; meniscus; systematic review.

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Conflict of interest statement

Competing interests: EMR is deputy editor of the scientific journal Osteoarthritis and Cartilage for which she receives an annual honorarium; she is the developer of Knee injury and Osteoarthritis Outcome Score (KOOS) and several other freely available patient-reported outcome measures (www.koos.nu); is cofounder of the Good Life with Osteoarthritis in Danmark (GLA:D), a not-for profit initiative to implement clinical guidelines in primary care hosted by University of Southern Denmark. CBJ is an Associate Editor of Osteoarthritis and Cartilage. KMK holds a CIHR Scientific Director Grant which supports his academic time; receives royalties as an author of Brukner and Khan’s Clinical Sports Medicine (book); received consulting fees from Aspetar Orthopaedic and Sports Medicine Hospital during 2019–2020; received some speaker honoraria for presenting at a small number of conferences (such as the Alaska branch of the American Physical Therapy Association); received support for attending International Olympic Committee events: Advanced Team Physician Course(s) and the 6th World Conference on Sports Injury and Illness Prevention; and participated in one UBC trial patient safety board. JJY is supported by PhD funding support from the Danish Foundation for Chiropractic Research and Post-graduate Education, Ontario Chiropractic Association, Canadian Memorial Chiropractic College, the National Chiropractic Mutual Insurance Company Foundation, and the University of Southern Denmark. JLW is supported by the Michael Smith Foundation for Health Research and the Arthritis Society. JLW is a Senior Associate Editor of the Journal of Orthopaedic and Sports Physical Therapy. KMC is a senior advisor of BJSM. KLM is a project leader of the Good Life with Osteoarthritis from Denmark – Australia (GLA:D), a not-for profit initiative to implement clinical guidelines in primary care hosted by La Trobe University. KLM has received grant funding from NHMRC Project Grant: SUPER rehabilitation for young people with old knees GNT1158500 that is not related to the present study but funds a study with similar aims as those of the OPTIKNEE group (optimising outcomes after knee surgery). AGC is a recipient of a National Health and Medical Research Council (NHMRC) of Australia Investigator Grant (GNT2008523). JLW, AGC and EM are Associate Editors of the British Journal of Sports Medicine (BJSM). All other authors declare no competing interests.

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