Key Takeaways & Executive Findings
- ā¢ā¢ Subjective patient-reported outcome measures have surpassed objective standards in frequency since 2009, reflecting a shift toward patient-centered care. ā¢ Early evaluation relied on Lysholm and Tegner scores, while later tools like IKDC-SKF, KOOS, and ACL-RSI became predominant. ā¢ Objective measures (KT1000/2000, Lachman test, hop test) remained stable but declined in overall use. ā¢ A combined approach using subjective and objective tools is recommended for comprehensive assessment of ACL reconstruction outcomes.
Abstract
BACKGROUND: A combination of subjective and objective evaluation criteria is often required to more accurately and comprehensively assess knee function in patients undergoing anterior cruciate ligament reconstruction. OBJECTIVE: To review the evolving trends in effectiveness and safety evaluation criteria after anterior cruciate ligament reconstruction and analyze the dynamic shift in the use of subjective and objective assessment tools. METHODS: A systematic search of PubMed and Embase was conducted up to August 22, 2023 to identify studies assessing knee function after anterior cruciate ligament reconstruction. A total of 136 eligible studies meeting the inclusion criteria were included. The frequency of each evaluation standard was extracted and analyzed over time using Origin 2025 software. RESULTS AND CONCLUSION: (1) Between 1990 and 2005, objective measures were widely applied. Since 2005, subjective scoring systems, particularly patient-reported outcome measures, have increased sharply, surpassing objective standards in frequency from 2009 onward. (2) Early use was dominated by the Lysholm scale and Tegner activity score, while the International Knee Documentation Committee-Subjective Knee Form, Knee Injury and Osteoarthritis Outcome Score, and anterior cruciate ligamentāreturn to sport after injury gradually emerged as the main tools in later years. (3) In contrast, objective assessments such as the KT1000/2000 arthrometer, Lachman test, and hop test remained relatively stable but showed an overall declining trend. (4) These findings indicate a paradigm shift from objective knee stability to patient-centered subjective experience in evaluating ACL reconstruction outcomes. (5) This study is the first to quantitatively reveal the dynamic evolution of mainstream evaluation tools, highlighting the current emphasis on combining subjective and objective criteria. The recommended combination is the International Knee Documentation Committee-Subjective Knee Form or Knee Injury and Osteoarthritis Outcome Score plus anterior cruciate ligamentāreturn to sport after injury plus KT1000/2000 or hop test, to comprehensively reflect knee function recovery and patient perception, providing an evidence base for future comprehensive assessment approaches.
1. Introduction
Anterior cruciate ligament (ACL) rupture is a common knee injury, typically occurring in sports requiring rapid direction changes, jumping, or pivoting. ACL injuries not only limit patients' physical activity but also significantly affect their quality of life and psychological well-being [1-7]. Arthroscopic ACL reconstruction is the standard treatment for patients with ACL rupture who wish to return to sports and reduce the impact of knee instability on daily activities, helping to restore knee structure and function [8-10]. However, there is considerable variability in functional recovery and return-to-sport success rates among patients after ACL reconstruction [11]. According to Ardern et al. [12], fewer than half of patients return to their pre-injury activity level or resume competitive sports at long-term follow-up. Therefore, evaluating the effectiveness and safety of ACL reconstruction is of paramount importance.
Currently, numerous evaluation standards exist for assessing knee function after ACL reconstruction, each with different emphases. Johnson et al. [13] reported 54 different evaluation standards used for this purpose, indicating that there is no unified 'gold standard' for evaluating ACL reconstruction outcomes. However, these standards can be broadly categorized into subjective and objective measures. Subjective measures, also known as patient-reported outcome measures (PROMs), directly reflect patients' perceptions of knee function and quality of life. Objective measures, such as KT1000/2000 arthrometer, Lachman test, and hop test, assess structural stability and functional performance. The choice and combination of these measures have evolved over time, reflecting changes in clinical priorities and medical philosophy.
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Li Chengke, Gao Miaomiao, Lei Lei, Ma Rongxing, Zhang Jingyu, Hu Yongcheng (2026). Dynamic evolution of evaluation standards for effectiveness and safety after anterior cruciate ligament reconstruction in the knee. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21424
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Frequently Asked Questions
What are the main findings of this study on ACL reconstruction evaluation standards?
The study found that subjective patient-reported outcome measures have increasingly been used since 2005 and surpassed objective standards in frequency from 2009 onward. Early tools like Lysholm and Tegner scores were dominant, while later tools such as IKDC-SKF, KOOS, and ACL-RSI became more common. Objective measures like KT1000/2000, Lachman test, and hop test remained stable but declined in overall use.
Why is a combination of subjective and objective evaluation recommended for ACL reconstruction?
A combination is recommended because subjective measures capture patient perceptions and quality of life, while objective measures provide structural and functional data. Together, they offer a more comprehensive assessment of knee function recovery and safety, aligning with the shift toward patient-centered care.
What is the recommended evaluation combination for ACL reconstruction outcomes?
The recommended combination is the International Knee Documentation Committee-Subjective Knee Form (IKDC-SKF) or Knee Injury and Osteoarthritis Outcome Score (KOOS) plus the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale plus KT1000/2000 arthrometer or hop test.
How did the use of subjective and objective measures change over time?
From 1990 to 2005, objective measures were widely used. Since 2005, subjective measures increased rapidly, surpassing objective measures in frequency from 2009 onward. This indicates a paradigm shift from focusing on structural stability to emphasizing patient experience.
What are the limitations of this study?
The study only searched PubMed and Embase, potentially missing important Chinese literature and lacking regional comparisons. It also excluded studies involving combined meniscal or cartilage injuries, which may limit the generalizability of the findings. Further research could explore associations between different assessment modes and long-term outcomes like post-traumatic osteoarthritis and reoperation rates.
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