Summary

This study report for the first time the PASS values for the SKV and the ACL-RSI which could be helpful for practicians in daily practice, or in their research, to interpret PROs results following an ACLR procedure. 

Abstract

Introduction

Patient's Reported Outcomes (PRO) are essential in evaluating subjects, especially following a surgical procedure as Anterior Cruciate Ligament Reconstruction (ACLR). However, their interpretations are not always clear or clinically relevant. In that way, the Patient Acceptable Symptom State (PASS) became a useful indicator but no threshold value has been defined for the Self Knee Value (SKV) and the Anterior Cruciate Ligament–Return to Sport after Injury (ALC-RSI). The aime of the study was to define the PASS thresholds for the SKV score and ACL-RSI scale in individuals 1 to 5 years after ACLR.

Methods

We conducted a retrospective data analysis from a prospective cohort study of primary ACLR. Patients completed a survey at the longest follow-up 1 to 5 years after reconstruction, containing the SKV score, the ACL-RSI scale, and a PASS question for each PRO. PASS was calculated using the area under the receiver operating characteristic (ROC) curve and absolute postoperative PROs.

Results

A total of 890 patients answered the questionnaire, at a mean follow-up of 39.2 ± 16.8 months after primary ACLR. 85.8% of them achieved an acceptable symptom state for the SKV (SKV-PASS-Y), and 76% for the ACL-RSI (ACL-RSI-PASS-Y). The ROC curve analysis allowed us to determine the PASS thresholds to 71% (Se 0.86, Sp 0.80) for the SKV and 60% (Se 0.84, Sp 0.74) for the ACL-RSI.

Conclusion

The PASS has been validated in the literature and this is the first study to determine the PASS thresholds for the SKV and the ACL-RSI scores with excellent sensitivity and excellent to acceptable specificity, at 1 to 5 years after primary ACLR. It allows practicians to extend the utilization of the PASS to PROs as the SKV and the ACL-RSI and thus facilitate further large cohort assessment.