Abstract

WHICH OUTCOME MEASURES TO USE TO EVALUATE THE RESULTS OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION SURGERY?

Hamza Atwi, Ali Mansour, Dr. Khodor Haidar Hassan* and Dr. Hassan Karaki

ABSTRACT

The success of Anterior cruciate ligament reconstruction requires a successful surgery, reeducation, supervision, and a targeted evaluation. The outcome measures (questionnaire) are a valuable tool to evaluate this operation. Objective – the purpose of this study is to determine the most appropriate outcome measure to evaluate patients after anterior cruciate ligament reconstruction based on a systemic review of 37 measure scores. Method – articles were pulled from PUBMED, GOOGLE, SCHOLAR and MEDLINE databases. Howe et al. have mentioned in their systemic review ten scales to evaluate different pathologies of the knee. We considered those ten scales and analyzed them individually. These articles had been published between 2000 and 2016 with no limitations concerning the age, and population’s sex in the studies. Results – in our study, we did not find any studies that confirm the use of the AKPS (Anterior Knee Pain Scale), WOMET (Western Ontario Meniscal Index), and WOMAC (Western Ontario and McMaster Universities Arthritis Index) scores to evaluate patients after ACL reconstruction. The AAOS (American Academy of Orthopedic Surgeons) was not specific to assess the knee after surgery, rather assess the inferior limb as a whole. The KOOS (Knee Injury and Osteoarthritis Outcomes Score), LEFS (Lower Extremity Functional Scale), IKDC (International Knee Documentation Committee), Lysholm, TAS (Tegner Activity Scale) scales had a specificity to evaluate post ACL reconstruction. Lysholm and TAS scales had issues when were applied alone. The results have demonstrated that the KOOS score does not work with patients that are less active or aged and that a unidimensional measure exists in two subscales. LEFFS and IKDS were found more specific with the advantage for the IKDC score regarding the evaluation of the patient’s quality of life. Conclusion – The LEFS and IKDC were the most specific scales between the scales cited in this review to evaluate patients after ACL reconstruction and the IKDC score was found superior concerning the evaluation of patient’s life quality. Also, The KOOS score is specific and frequently utilized after ACL reconstruction, yet it doesn’t show specificity to other less active or aged patients. A debate is still ongoing concerning its efficacy after 20 weeks of the ACL reconstitution. Lysholm and Tegner are insufficient when applied alone.

Keywords: ACL, RLCA, IKDC, KOOS, AKPS, AAOS, WOMET, WOMAC, TAS.