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Cited by 348Knee injuries and reconstruction techniquesFoot and Ankle SurgerySports injuries and prevention

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Consensus criteria for defining “successful outcome” after ACL injury and reconstruction: A Delaware-Oslo ACL cohort investigation

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Lynch, Andrew D, Logerstedt, David S, Grindem, Hege, Eitzen, Ingrid, Hicks, Gregory E, Axe, Michael J, Engebretsen, Lars, Risberg, May Arna, Snyder-Mackler, Lynn·2015·British Journal of Sports Medicine
DOI 10.1136/bjsports-2013-092299PMC PMC3900606
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Abstract

Background: No gold standard exists for identifying successful outcomes 1 and 2 years after operative and non-operative management of anterior cruciate ligament (ACL) injury. This limits the ability of a researcher and clinicians to compare and contrast the results of interventions. Purpose: To establish a consensus based on expert consensus of measures that define successful outcomes 1 and 2 years after ACL injury or reconstruction. Methods: Members of international sports medicine associations, including the American Orthopaedic Society for Sports Medicine, the European Society for Sports Traumatology, Surgery, and Knee Arthroscopy and the American Physical Therapy Association, were sent a survey via email. Blinded responses were analysed for trends with frequency counts. A summed importance percentage (SIP) was calculated and 80% SIP operationally indicated consensus. Results: 1779 responses were obtained. Consensus was achieved for six measures in operative and non-operative management: the absence of giving way, patient return to sports, quadriceps and hamstrings’ strength greater than 90% of the uninvolved limb, the patient having not more than a mild knee joint effusion and using patient-reported outcomes (PRO). No single PRO achieved consensus, but threshold scores between 85 and 90 were established for PROs concerning patient performance. Conclusions: The consensus identified six measures important for successful outcome after ACL injury or reconstruction. These represent all levels of the International Classification of Functioning: effusion, giving way, muscle strength (body structure and function), PRO (activity and participation) and return to sport (participation), and should be included to allow for comparison between interventions.

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  • Psychological factors such as fear of reinjury, anxiety, and confidence have consistently been associated with recovery trajectories following ACLR, often exerting a greater influence on return-to-activity than physical impairments alone.

    “Psychological factors such as fear of reinjury, anxiety, and confidence have consistently been associated with recovery trajectories following ACLR, often exerting a greater influence on return-to-activity than physical impairments alone.29”

    From Biopsychosocial profiles following ACL reconstruction: A latent class analysis of barriers to return-to-activity (2025) · cites this paper as [29]

    The Discussion (Outcome Criteria Achieving Consensus; page unavailable) says fear of reinjury can affect return to sport and that confidence can affect post-return ability, even when knee function permits participation. It does not address anxiety or establish consistent associations with recovery trajectories, nor does it show that psychological factors generally have a greater influence than physical impairments. (LLM, conf=0.86)

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Metadata

Authors
Lynch, A. D., Logerstedt, D. S., Grindem, H., Eitzen, I., Hicks, G. E., Axe, M. J., Engebretsen, L., Risberg, M. A., & Snyder-Mackler, L.
Affiliations
  • University of Pittsburgh (US)
  • University of Delaware (US)
  • Norwegian School of Sport Sciences (NO)
  • Oslo University Hospital (NO)
Corresponding author
Lynch, Andrew D
ORCID
Venue
British Journal of Sports Medicine
Publisher
BMJ
Published
2013-07-23
Volume
49
Issue
5
Pages
335-342
ISSN
  • 0306-3674 (ISSN-L)
  • 1473-0480
DOI
10.1136/bjsports-2013-092299
PMC
PMC3900606
OpenAlex
W2163302793
Cited by
348
References
0
Citations by year
2026: 27 · 2025: 28 · 2024: 43 · 2023: 32 · 2022: 29 · 2021: 37 · 2020: 40 · 2019: 30 · 2018: 27 · 2017: 21 · 2016: 16 · 2015: 12 · 2014: 4 · 2013: 2
FWCI
10.84
Type
journal article
Language
en
Open access
Locations
  • British Journal of Sports Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • University of Delaware
  • American Orthopaedic Society for Sports Medicine
  • Defense Advanced Research Projects Agency
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD037985, R37HD037985, T32HD007490)
Topics
  • Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Foot and Ankle Surgery
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
Keywords
anterior cruciate ligament injury, anterior cruciate ligament reconstruction, outcome measures, expert consensus, return to sport, muscle strength, knee effusion, patient-reported outcomes, International Classification of Functioning, Disability and Health, conservative treatment
MeSH terms
Anterior Cruciate Ligament Injuries, Humans, Knee Injuries, Orthopedics, Practice Patterns, Physicians', Rehabilitation, Sports Medicine, Anterior Cruciate Ligament, Treatment Outcome, Anterior Cruciate Ligament Reconstruction

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