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Psychometric Properties of Patient-Reported Outcome Measures for Use in Patients with Anterior Cruciate Ligament Injuries: A Systematic Review
Abstract
Background: Despite the high costs of anterior cruciate ligament (ACL) injuries to patients and society, we are not aware of any systematic reviews that have been performed on patient-reported outcome instruments designed for this patient population. The purpose of the present review is to identify currently available patient-reported outcome questionnaires for patients with ACL injuries, to appraise and assess the methodological quality and psychometric evidence of the evaluations of identified instruments, and to summarize the overall evidence for each included questionnaire. Methods: A computerized literature search was performed to identify articles appropriate for inclusion in this systematic review. Search terms were related to outcome instruments, ACL injuries, and psychometric properties. Two independent reviewers assessed the suitability of articles for inclusion. The methodological quality of instrument evaluation was assessed with use of the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Psychometric properties were assessed with use of the quality criteria established by Terwee et al. The 2 assessments were synthesized to obtain an overall rating of the psychometric evidence for each questionnaire. Results: Forty-one studies investigating 24 instruments were included. The International Knee Documentation Committee (IKDC) Form and the Knee injury and Osteoarthritis Outcome Score (KOOS) were the most frequently assessed instruments. The ACL-Return to Sport after Injury (ACL-RSI) scale had 6 properties with positive evidence and was the highest-quality instrument overall. Conclusions: Many of the included studies had low COSMIN ratings. The ACL-RSI is a reliable and valid scale to measure outcomes for patients with ACL injuries. Further assessments with improved methodological quality are needed to determine the psychometric properties of other instruments.
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Several of the PROs (e.g., ACL-RSI, IKDC, KOOS, PROMIS) have documented psychometric properties in this population, including internal consistency, construct validity, and responsiveness to change.
“Additionally, several of the PROs (e.g., ACL-RSI, IKDC, KOOS, PROMIS) have documented psychometric properties in this population, including internal consistency, construct validity, and responsiveness to change.18”
From Biopsychosocial profiles following ACL reconstruction: A latent class analysis of barriers to return-to-activity (2025) · cites this paper as [18]
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Quality criteria were proposed for measurement properties of health status questionnaires
Terwee, C. B., Bot, S. D. M., de Boer, M. R., van der Windt, D. A. W. M., Knol, D. L., Dekker, J., Bouter, L. M., & de Vet, H. C. W. (2007) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2006.03.012 · Cited by 10,764
2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group
Furlan, A. D., Pennick, V., Bombardier, C., & van Tulder, M. (2009) · Spine · doi:10.1097/brs.0b013e3181b1c99f · Cited by 1,663
Psychometric properties of the TSK-11: A shortened version of the Tampa Scale for Kinesiophobia
Woby, S. R., Roach, N. K., Urmston, M., & Watson, P. J. (2005) · Pain · doi:10.1016/j.pain.2005.05.029 · Cited by 923
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Petushek, E., Harkey, M. S., Santiago, K., Stamm, A., Baez, S., Diekfuss, J. A., Myer, G. D., & Kuenze, C. (2025) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2025.08.004 · Cited by 5
Metadata
- Authors
- Gagnier, J. J., Shen, Y., & Huang, H.
- Affiliations
- University of Michigan (US)
- Venue
- JBJS Reviews
- Published
- 2018-04
- Volume
- 6
- Issue
- 4
- Pages
- e5-e5
- ISSN
- 2329-9185 (ISSN-L)
- OpenAlex
- W2797632568
- Cited by
- 80
- References
- 3
- Citations by year
- 2026: 9 · 2025: 15 · 2024: 18 · 2023: 15 · 2022: 5 · 2021: 4 · 2020: 8 · 2019: 6
- FWCI
- 0.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JBJS Reviews (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Surgery › Total Knee Arthroplasty Outcomes
- Keywords
- anterior cruciate ligament injury, patient-reported outcome measures, psychometric properties, instrument validation, COSMIN checklist, KOOS, ACL-RSI scale, return to sport
- MeSH terms
- Anterior Cruciate Ligament Injuries, Patient Reported Outcome Measures, Adult, Female, Humans, Male, Middle Aged, Psychometrics, Surveys and Questionnaires, Reproducibility of Results, Treatment Outcome, Anterior Cruciate Ligament Reconstruction
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