Quantifying the burden of injury; the value of patient reported outcome measures following paediatric anterior cruciate ligament rupture

Abstract

Introduction: Patient Reported Outcome Measures (PROMs) are valuable tools in assessing patient perceptions following musculoskeletal injury. This study aims to quantify self-reported symptoms, physical impairments, and quality of life (QoL) in a paediatric population following anterior cruciate ligament (ACL) injury, investigate the influence of patient factors on these domains, and compare scores with population norms. Methods: Data was extracted from a prospective longitudinal multi-disciplinary ACL registry housed at Queensland Children’s Hospital. Three PROMs were analysed pre-operatively; Pedi International Knee Documentation Committee (Pedi-IKDC), Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABs), and Knee Injury and Osteoarthritis Outcome Score Child (KOOS-Child). KOOS-Child reports on five separate domains: Symptoms, Pain, Activities of Daily Living (ADLs), Sport, and QoL. Relationships between scores and multiple demographic, physical, and temporal variables were examined. Results: Datasets were available for 286 patients. Median time from injury to PROM completion was 108 days (IQR = 49-180) (range 4-2083). Median age was 14.7 (IQR = 13.2-15.7) (range 7.4-17.9). 62.8% had concomitant meniscal pathology. Patients with meniscal tears scored lower on all KOOS-Child domains (p < 0.05) except for Pain. Patients with lateral and meniscal injuries trended towards even lower scores in Symptoms and Sport. There was a positive but weak relationship between Pedi-IKDC and time from injury (r(284) = .22, p = .004) in patients with meniscal injury. For all patients, there were positive but weak correlations between KOOS scores (except QoL) and time from injury (r(284) = .20 - .30, p < .001). These relationships increased in strength and significance when meniscal pathology was accounted for but remained weak. The cohort scored lower in KOOS-Child than an age and sex matched Australian population, with Pain 75.0 vs 93.4, Symptoms 78.6 vs 94.5, ADLs 90.9 vs 97.8, Sport 47.4 vs 95.5, and QoL 42.0 vs 95.9. Similarly, Pedi-FABS (7 vs 15.4) and Pedi-IKDC (58.9 vs 86.7) scores were lower when compared to North American non-injured populations. 34% of the normal Pedi-IKDC sample reached the ceiling value of 100, whereas none of our cohort achieved this. Calculation of Cronbach’s alpha revealed that all instruments demonstrated good or excellent internal consistency except for KOOS-Symptoms (α = 0.696) which approached acceptability. Only mild increases in adjusted co-efficient values were observed for Pedi-IKDC, KOOS-Symptoms, and Pedi-FABS. Discussion: PROM data from a large predominately adolescent sample with ruptured ACLs revealed disturbingly poor scores even several months after injury. This was particularly the case in domains of QoL, sport, and physical activity levels. The presence of meniscal tears and less time from injury were generally associated with lower scores. QoL did not improve with time. This data builds a robust base for further research on the effect of both operative and non-operative intervention on PROMs in a paediatric population, specifically into improving short- and medium-term quality of life outcomes in the paediatric population who may be significantly psychosocially impacted by reduced activity participation. Impact/Application to the field: Psychosocial concerns and physical activity participation should be assessed and managed in adolescents following ACL injury. Specific attention to addressing deficits in PROMs should be paid in patients with concomitant meniscal pathology. Declaration: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.