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.