Lack of Correlation Between Functional, Clinical, and PROM Outcomes 1 Year Post-ACLR

Overview

This study evaluated correlations between functional performance tests, clinical and instrumented knee laxity, and patient-reported outcome measures (PROMs) one year after anterior cruciate ligament reconstruction (ACLR). Results demonstrated no strong correlations among these outcome domains, suggesting that each provides distinct information about patient recovery.

Background

Anterior cruciate ligament reconstruction outcomes are commonly assessed using PROMs, clinical laxity measures, muscle strength, balance, and functional tests. PROMs are often prioritized as they reflect patients’ subjective condition, while functional tests help determine readiness to return to sport. However, functional tests are complex and time-consuming, and it remains unclear whether PROMs alone can represent overall recovery. This study aimed to clarify the relationships among these assessment modalities one year post-ACLR.

Data Highlights

A total of 151 patients who underwent primary ACLR between 2019 and 2021 were evaluated at 1 year postoperatively. Assessments included four functional performance tests, clinical and instrumented knee laxity measurements using the Rolimeter, and four PROMs: Lysholm score, Subjective IKDC, KNEES-ACL, and KOOS. Activity level was measured by the Tegner Score. Meniscal and cartilage pathologies were recorded but not exclusion criteria.

Key Findings

• No strong correlations were found between functional performance tests and PROM scores at 1 year post-ACLR.
• Clinical and instrumented knee laxity measures did not correlate significantly with PROM outcomes or functional test results.
• Functional tests, despite their complexity, provided unique information not captured by PROMs or laxity assessments.
• Patients with good mechanical knee stability did not necessarily report high subjective outcome scores or demonstrate superior functional performance.
• The findings align with previous studies showing weak or absent correlations between subjective and objective measures after ACLR.

Clinical Implications

Clinicians should be cautious in relying solely on PROMs to assess recovery after ACL reconstruction, as these do not fully reflect functional performance or mechanical knee stability. A comprehensive evaluation including functional tests and clinical laxity measurements is recommended to guide return-to-sport decisions and rehabilitation progress. This multidimensional approach ensures a more accurate understanding of patient status.

Conclusion

One year following ACL reconstruction, functional performance, clinical laxity, and patient-reported outcomes represent distinct aspects of recovery with limited correlation. Reporting multiple outcome domains is necessary to capture the full spectrum of patient recovery.

References

1. Author/Source/Year -- Lack of Correlation Between Functional Performance Assessments, Clinical Evaluations, and Patient-Reported Outcomes One Year Following Anterior Cruciate Ligament Reconstruction