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Clinical outcomes after anterior cruciate ligament injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group
  1. Eleonor Svantesson1,2,
  2. Eric Hamrin Senorski2,3,
  3. Kate E Webster4,
  4. Jón Karlsson1,2,5,
  5. Theresa Diermeier6,
  6. Benjamin B Rothrauff7,
  7. Sean J Meredith7,8,
  8. Thomas Rauer7,9,
  9. James J Irrgang10,11,
  10. Kurt P Spindler12,
  11. C Benjamin Ma13,
  12. Volker Musahl10
  13. The Panther Symposium ACL Injury Clinical Outcomes Consensus Group
    1. 1 Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
    2. 2 Gothenburg Sports and Trauma Research Center, Gothenburg, Sweden
    3. 3 Department of Rehabilitation and Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
    4. 4 School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
    5. 5 Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
    6. 6 Department of Sports Orthopedic, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
    7. 7 UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    8. 8 Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
    9. 9 Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
    10. 10 Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
    11. 11 Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    12. 12 Sports Health Center, Cleveland Clinic, Garfield Heights, Ohio, USA
    13. 13 Department of Orthopaedic Surgery, University of California, San Francisco, California, USA
    1. Correspondence to Dr Eleonor Svantesson, Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, Goteborg, Sweden; eleonor.svantesson{at}outlook.com

    Abstract

    Purpose A stringent outcome assessment is a key aspect for establishing evidence-based clinical guidelines for anterior cruciate ligament (ACL) injury treatment. The aim of this consensus statement was to establish what data should be reported when conducting an ACL outcome study, what specific outcome measurements should be used and at what follow-up time those outcomes should be assessed.

    Methods To establish a standardised assessment of clinical outcome after ACL treatment, a consensus meeting including a multidisciplinary group of ACL experts was held at the ACL Consensus Meeting Panther Symposium, Pittsburgh, PA, USA, in June 2019. The group reached consensus on nine statements by using a modified Delphi method.

    Results In general, outcomes after ACL treatment can be divided into four robust categories—early adverse events, patient-reported outcomes, ACL graft failure/recurrent ligament disruption, and clinical measures of knee function and structure. A comprehensive assessment following ACL treatment should aim to provide a complete overview of the treatment result, optimally including the various aspects of outcome categories. For most research questions, a minimum follow-up of 2 years with an optimal follow-up rate of 80% is necessary to achieve a comprehensive assessment. This should include clinical examination, any sustained re-injuries, validated knee-specific patient-reported outcomes and Health-Related Quality of Life questionnaires. In the mid-term to long-term follow-up, the presence of osteoarthritis should be evaluated.

    Conclusion This consensus paper provides practical guidelines for how the aforementioned entities of outcomes should be reported and suggests the preferred tools for a reliable and valid assessment of outcome after ACL treatment.

    Level of Evidence Level V.

    • knee
    • anterior cruciate ligament
    • ligaments
    • knee injuries
    • patient outcome assessment
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    Footnotes

    • Twitter @senorski, @BenRothrauff

    • Presented at This article has been co-published in Orthopaedic Journal of Sports Medicine and Knee Surgery SportsTraumatology Arthroscopy.

    • Collaborators Freddie H Fu, Olufemi R Ayeni, Francesco Della Villa, Stefano Della Villa, Scott Dye, Mario Ferretti, Alan Getgood, Timo Järvelä, Christopher C Kaeding, Ryosuke Kuroda, Bryson Lesniak, Robert G Marx, Gregory B Maletis, Leo Pinczewski, Anil Ranawat, Bruce Reider, Romain Seil, Carola van Eck, Brian R Wolf, Patrick Yung, Stefano Zaffagnini, Ming Hao Zheng.

    • Contributors Each named author has substantially contributed to the design of the work, to the drafting of the manuscript and to critically revising the manuscript for important intellectual content. Each author in the Panther Symposium ACL Injury Clinical Outcomes Consensus Group has contributed according to the group authorship guidelines. All authors approve publication of the final manuscript and are accountable for all aspects of the work.

    • Funding We would like to acknowledge that the ACL Consensus Meeting Panther Symposium at the UPMC, Pittsburgh, was sponsored by Smith&Nephew, the UPMC, Elizur, Arthrex, Conmed, DJO global, Mid-Atlantic surgical systems, RTI Surgical and BlackRhino Medical.

    • Competing interests JK is the Editor-in-Chief of KSSTA. JJI reports grants from American Orthopaedic Society for Sports Medicine, outside the submitted work. KPS reports grants from NIH/NIAMS R01 AR053684, grants from NIH/NIAMS R01 AR074131, grants from NIH/NIAMS R01 AR075422-01, other from NFL, other from Service Excellence, other from Mitek, other from Flexion Therapeutics, other from Samumed, other from NovoPedics, other from nPhase, outside the submitted work. VM reports educational grants, consulting fees, and speaking fees from Smith & Nephew and educational grants from Arthrex. Dr Ayeni reports Speakers Bureau from Conmed, honoraria from DJO, outside the submitted work. Dr Dye reports personal fees from Zimmer Biomet, outside the submitted work. Dr Fu reports educational support and hospitality payments from Smith & Nephew, outside the submitted work. Dr Getgood reports grants and personal fees from Smith & Nephew, grants and personal fees from Ossur, personal fees from Graymont, personal fees from Olympus, outside the submitted work. Dr Kuroda reports grants and personal fees from Smith & Nephew KK, grants and personal fees from Jimmer Biomet, grants from Stryker Japan KK, grants and personal fees from Johnson & Johnson KK, personal fees from Medacta International, personal fees from Arthrex, Inc, personal fees from Japan Tissue Engineering Co., Ltd, personal fees from Hirosaki Life Science Innovation, Inc, personal fees from Arthrex Japan G.K., outside the submitted work. Dr Lesniak reports personal fees and other from Wolters Kluwer Health—Lippincott Williams & Wilkins, outside the submitted work. Dr Marx reports personal fees from Journal of Bone and Joint Surgery, personal fees from Journal of Bone and Joint Surgery Evidence Based Orthopedics, personal fees from MEND Nutrition Inc., personal fees from Springer & Demos Health, outside the submitted work. Dr Pinczewski reports personal fees from Australian Biotechnologies, grants from Australian Orthopaedic Association, grants from Friends of the Mater Foundation, personal fees from Signature Orthopaedics, grants and personal fees from Smith and Newphew, outside the submitted work. In addition, Dr Pinczewski has a patent Surgical screw pending to Hip Developments Pty Ltd., a patent Process and article for knee reconstruction pending to Smith & Nephew, Inc., a patent Method of arthroplasty on a knee joint and apparatus for use in same pending to Smith & Nephew, Inc., and a patent Manually operated medical pump pending to SURGICAL APPS Pty Ltd. Dr Ranawat reports other from Enhatch, other from Conformis, other from Stryker, other from Smith and Nephew, other from Arthrex, Inc., from Anika, from Bodycad, outside the submitted work. Dr Reider reports other from Smith and Nephew, personal fees from Elsevier, other from Merck, other from Johnson and Johnson, outside the submitted work. Dr Wolf reports personal fees from ConMed, from null, outside the submitted work. Dr Zheng is the founder of Orthocell Ltd and holds share of Orthocell that is not directly related to the work.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data availability statement Data sharing not applicable since no data sets were generated or analysed for this consensus statement.

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