Application of machine learning in the context of reoperation, outcome and management after ACL reconstruction - A systematic review

Abstract

Introduction: Machine learning-based tools are becoming increasingly popular in clinical practice. They offer new possibilities but are also limited in their reliability and accuracy.

Objectives: The present systematic review updates and discusses the existing literature regarding machine learning algorithm-based tools to predict outcome and management in patients after ACL reconstruction.

Method: PubMed was searched for articles containing machine learning algorithms related to anterior cruciate ligament reconstruction and its outcome and management. No additional filters or time constraints were used. All eligible studies were accessed by hand.

Results: After screening of 115 articles, 15 were included. Six studies evaluated predictors for reoperation after ACL surgery. Four studies investigated the clinical outcome prediction after ACL reconstruction including prediction of secondary meniscus tear and secondary knee osteoarthritis. Single topics addressed in patients with ACL reconstruction were costs, opioid use, the need for a femoral nerve block, short term complications, hospital admission, and reduction of the burden to complete the Knee Osteoarthritis and Outcome score questionnaire. Predictive power was very heterogeneous, depending on the specific research question and parameters included.

Conclusion: New machine-learning tools offer interesting insights into variables affecting the target outcome and general management of patients with ACL reconstruction. While present machine-learning based prediction models seem to outperform previous existing benchmark regression models, their predictive ability often is still too low to base individual decision making on them. With the rapid progress observed over the last few years, it is conceivable that this might change, however, in the foreseeable future.

Keywords: Anterior cruciate ligament reconstruction; Artificial intelligence; Machine learning; Outcome prediction.