Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 21;6(8):971-982.
doi: 10.1302/2633-1462.68.BJO-2025-0005.R1.

Outcomes reported in trials of children and adolescent knee injuries : a systematic review

Ignatius Liew, Wen Xian Low  1 , Adeel Ikram  2   3 , Stephen McDonnell, Ben Arthur Marson  4   5 ; Core Kids Knee Steering committee; Adeel Ikram  6 , Arman Memarzadeh  7 , Ben A Marson  8 , Benjamin Gompels  7 , Caroline Hing  9 , Dimitrios Manoukian, Faye Grace  10 , Ignatius Liew  7 , Jay Ebert  11 , Jimmy Ng  12 , Joanna Thomas  13 , Neeraj M Patel  14 , Nicolas Nicolaou  15 , Peter D'Alessandro  16 , Pranai Buddhdev  17 , Sheba Basheer  13 , Stephen McDonnell  7 , Toby Smith  18 , Wen Xian Low  19 , Hannah Boddy  10
Affiliations

Outcomes reported in trials of children and adolescent knee injuries : a systematic review

Ignatius Liew et al. Bone Jt Open. .

Abstract

Aims: To systematically review published evidence of outcomes reported in trials of knee injuries in children and adolescents.

Methods: We searched the following databases from inception to 29 July 2024: OVID MEDLINE, Embase, Cochrane CENTRAL, Clinicaltrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). In total, 13,146 studies were identified; after removing duplicates, 9,796 studies were yielded for screening following PRISMA guidelines. Data extraction was performed by two researchers, and 15 trials were included in the final analysis. Outcomes reported by trials were mapped to the domains within the WHO International Classification of Function framework (ICF), comprising four main categories: Body functions (b), Activities and participation (d), Environmental factors (e), and Body structure (s).

Results: A total of 83 outcomes were identified from 15 trials, representing 35 WHO domains. The most common domain reported mapped to the ICF framework was structure of the lower limb (s750; 93.3%), followed by sensation of pain (b280; 86.7%), mobility of joint function (b710; 86.7%), and function of the joints and bones (b729; 86.7%). Patient satisfaction was reported in two trials (13.3%) trials. Primary outcomes were not reported in seven trials (46.6%). Pedi-International Knee Documentation Committee (IKDC) was the most common patient-reported outcome measure in seven trials (46.6%).

Conclusion: Outcome measure tools reported in children and adolescent knee injuries are highly variable and inconsistent. Currently, there are no core outcome sets (COS) for these injuries, highlighting an urgent need to improve standardization and consistency in trial reporting. A key recommendation for the COS development is accounting for pathology-specific subcategories, given the difference in emphasis on WHO ICF domains across various knee injuries. In the future, these approaches will ensure the COS has comprehensive yet unique priorities for each condition.

PubMed Disclaimer

Conflict of interest statement

I. Liew and S. McDonnell report a minor research grant from AO UK, funding from the Nottingham NIHR Biomedical Research Centre, and the Gwen Fish Fund (The Orthopaedic Trust) to fund the cost of this study and publication, as well as the other cost and consumables in the overall project 'development of the core kids knee outcome set for childhood knee injuries'. The Royal College of Surgeons Edinburgh, Orthopaedic Research UK, and British Orthopaedic Association have awarded research fellowships for the salary and stipend of I. Liew's PhD, unrelated to this study. B. A. Marson reports institutional funding from the Gwen Fish Orthopaedic Fund, AOUKI, and the Nottingham MSK Biomedical Research Centre for this study and publication. B. A. Marson also reports funding from the National Institute of Health Research, unrelated to this study.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram, which included searches of the following databases and registers: seven completed and published trials, six active trials and two trials not yet recruiting. WHO ICTPR, World Health Organization International Clinical Trials Registry Platform.
Fig. 2
Fig. 2
Patient-reported outcome measures (PROMs) used in trials. ACL, anterior cruciate ligament; EQ5D-Y, EuroQol-five-dimension questionnaire-Youth; HSS Pedi-FABS, the Hospital for Special Surgery Paediatric Functional Activity Brief Scale; Hughston VAS, Hughston visual analogue scale; IKDC, International Knee Documentation Committee; KOOS-Child, Knee injury and Osteoarthritis Outcome Score for Children; KOOS, Knee Injury and Osteoarthritis Outcome Score; KOOS QOL, Knee injury and Osteoarthritis Outcome Score quality of life subdomain; Pedi-IKDC, Paediatric International Knee Documentation Committee; PedsQL, paediatric quality of life; PROMIS PA-8a, patient-reported outcomes measurement information system paediatric anxiety short form 8 a; PROMIS PDS-8a, patient-reported outcomes measurement information system paediatric depressive symptoms short form 8 a; PROMIS PM-7a, patient-reported outcomes measurement information system paediatric mobility short form 7 a; PROMIS PPA-8a, patient-reported outcomes measurement information system paediatric physical activity short form 8 a.
See this image and copyright information in PMC

References

    1. Osmani HT, Nicolaou N, Anand S, Gower J, Metcalfe A, McDonnell S. Future research priorities for soft-tissue knee injuries. Bone Joint J. 2024;106-B(3):232–239. doi: 10.1302/0301-620X.106B3.BJJ-2023-0946.R1. - DOI - PubMed
    1. Abram SGF, Price AJ, Judge A, Beard DJ. Anterior cruciate ligament (ACL) reconstruction and meniscal repair rates have both increased in the past 20 years in England: hospital statistics from 1997 to 2017. Br J Sports Med. 2020;54(5):286–291. doi: 10.1136/bjsports-2018-100195. - DOI - PubMed
    1. Weitz FK, Sillanpää PJ, Mattila VM. The incidence of paediatric ACL injury is increasing in Finland. Knee Surg Sports Traumatol Arthrosc. 2020;28(2):363–368. doi: 10.1007/s00167-019-05553-9. - DOI - PMC - PubMed
    1. Dodwell ER, Lamont LE, Green DW, Pan TJ, Marx RG, Lyman S. 20 years of pediatric anterior cruciate ligament reconstruction in New York State. Am J Sports Med. 2014;42(3):675–680. doi: 10.1177/0363546513518412. - DOI - PubMed
    1. Tepolt FA, Feldman L, Kocher MS. Trends in pediatric ACL reconstruction from the PHIS database. J Pediatr Orthop. 2018;38(9):e490–e494. doi: 10.1097/BPO.0000000000001222. - DOI - PubMed

Publication types