Summary

Many scoring systems quantify outcome following ACL surgery, yet we have identified that they are lacking in detail for the elite athlete and highlight the need for a new specific outcome measure for this population.

Abstract

Introduction

Many outcome measures exist to assess ACL reconstruction surgery outcomes. The 5 most common in the literature are IKDC, Lysohlm, Tegner, KOOS and Cincinnati scores. These are excellent at describing surgical outcomes but it is unknown if they address whether an athlete is suitable to return to play and whether the level of performance will be the same for that athlete.

Methods

We reviewed the 5 most common outcome scores used following ACL reconstruction. We recorded the frequency of use of the scores, the relevance of the score to the time to return to play in the elite athlete and its determination of the time when it is suitable for an athlete to return to play by calculating the contribution of sport to the overall score.

Results

IKDC (71.4% of studies), Lysohlm (63%), Tegner (42%), KOOS (20.2%) & Cincinnati (8.4%) are the most common scores used. They are a mean 30 years old (range 19 to 35 years). Collectively 49% (range 12% to 80%) of the questions within these scoring systems were related to sport and 18.5% (range 12% to 40%) specific to sport. It is possible for a patient to achieve a score of 88% post ACL reconstruction and not have a return to sport. In terms of specifically recording return to play this was covered by one score. The Tegner activity scale is the only one that qualifies the level of return to play.

Conclusion

The majority of the literature describes outcomes from ACL surgery that does not convey relevance to the elite athlete nor defines when an elite athlete may return to play. A sport specific ACL outcome assessment for the elite athlete would help determine return to play time and return to performance level to aid research in this specialist sub-group of patients.