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Outcome measures in clinical ACL studies: an analysis of highly cited level I trials

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Clinical research in the area of anterior cruciate ligament (ACL) injury has shown substantial growth during the last decade. This was accompanied by the establishment of a wide range of outcome measures used to address the demands of clinical studies. The aim of this study was to evaluate outcome measures reported by highly cited level I trials in ACL research and identify factors influencing citation metrics.

Methods

The database of the Institute for Scientific Information (ISI) was utilized to screen journals under the subject categories “Orthopaedics”, “Sports Sciences”, “Radiology” and “General medicine” for the 50 most cited level I ACL trials based on predefined inclusion criteria. Metadata, citation metrics and outcome measures were extracted for each article. Frequencies of reported outcome measures were calculated, and a multiple linear regression model applied to identify factors influencing citation metrics.

Results

Two independent outcome measures demonstrated an influence on acquisition of citations including: 1—report of the pivot-shift test and 2—inclusion of the Knee Injury and Osteoarthritis Outcome (KOOS) score. Furthermore, highly cited ACL trials frequently reported KT-1000 measures of anterior translation, range of motion (ROM), graft failure, Lysholm, Tegner and subjective International Knee Documentation (IKDC) scores.

Conclusion

This analysis reflects on the outcome measures utilized in highly cited level I trials impacting the field of ACL research. It also identifies factors likely to influence acquisition of citations. This is of both clinical and academic relevance when choosing appropriate measures for post-operative outcome evaluation after ACL surgery.

Level of evidence

I.

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References

  1. Ahmad SS, Evangelopoulos DS, Abbasian M, Roder C, Kohl S (2014) The hundred most-cited publications in orthopaedic knee research. J Bone Joint Surg Am 96(22):e190

    Article  PubMed  Google Scholar 

  2. Aksnes DW (2003) Characteristics of highly cited papers. Res Eval 12(3):159–170

    Article  Google Scholar 

  3. Bohn MB, Sorensen H, Petersen MK, Soballe K, Lind M (2015) Rotational laxity after anatomical ACL reconstruction measured by 3-D motion analysis: a prospective randomized clinical trial comparing anatomic and nonanatomic ACL reconstruction techniques. Knee Surg Sports Traumatol Arthrosc 23(12):3473–3481

    Article  PubMed  Google Scholar 

  4. Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR (1994) Fate of the ACL-injured patient a prospective outcome study. Am J Sports Med 22(5):632–644

    Article  CAS  PubMed  Google Scholar 

  5. Desai N, Björnsson H, Musahl V, Bhandari M, Petzold M, Fu FH, Samuelsson K (2014) Anatomic single-versus double-bundle ACL reconstruction: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 22(5):1009–1023

    Article  PubMed  Google Scholar 

  6. Drogset JO, Grontvedt T, Robak OR, Molster A, Viset AT, Engebretsen L (2006) A sixteen-year follow-up of three operative techniques for the treatment of acute ruptures of the anterior cruciate ligament. J Bone Joint Surg Am 88(5):944–952

    PubMed  Google Scholar 

  7. Feagin JA Jr, Curl WW (1976) Isolated tear of the anterior cruciate ligament: 5-year follow-up study. Am J Sports Med 4(3):95–100

    Article  PubMed  Google Scholar 

  8. Girgis FG, Marshall JL, Monajem A (1975) The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res 106:216–231

    Article  Google Scholar 

  9. Granan L-P, Forssblad M, Lind M, Engebretsen L (2009) The Scandinavian ACL registries 2004–2007: baseline epidemiology. Acta Orthop 80(5):563–567

    Article  PubMed  PubMed Central  Google Scholar 

  10. Grimes DA, Schulz KF (2002) An overview of clinical research: the lay of the land. Lancet 359(9300):57–61

    Article  PubMed  Google Scholar 

  11. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928

    Article  PubMed  PubMed Central  Google Scholar 

  12. http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/

  13. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12

    Article  CAS  PubMed  Google Scholar 

  14. Johnson DS, Smith RB (2001) Outcome measurement in the ACL deficient knee—what’s the score? Knee 8(1):51–57

    Article  CAS  PubMed  Google Scholar 

  15. Kuroda R, Hoshino Y, Kubo S, Araki D, Oka S, Nagamune K, Kurosaka M (2012) Similarities and differences of diagnostic manual tests for anterior cruciate ligament insufficiency: a global survey and kinematics assessment. Am J Sports Med 40(1):91–99

    Article  PubMed  Google Scholar 

  16. Lind M, Menhert F, Pedersen AB (2009) The first results from the Danish ACL reconstruction registry: epidemiologic and 2 year follow-up results from 5818 knee ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 17(2):117–124

    Article  PubMed  Google Scholar 

  17. Lohmander LS, Englund PM, Dahl LL, Roos EM (2007) The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 35(10):1756–1769

    Article  PubMed  Google Scholar 

  18. Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG (2009) Epidemiology of anterior cruciate ligament reconstruction. J Bone Joint Surg Am 91(10):2321–2328

    Article  PubMed  Google Scholar 

  19. Mascarenhas R, Cvetanovich GL, Sayegh ET, Verma NN, Cole BJ, Bush-Joseph C, Bach BR Jr (2015) Does double-bundle anterior cruciate ligament reconstruction improve postoperative knee stability compared with single-bundle techniques? A systematic review of overlapping meta-analyses. Arthroscopy 31(6):1185–1196

    Article  PubMed  Google Scholar 

  20. Mascarenhas R, Saltzman BM, Sayegh ET, Verma NN, Cole BJ, Bush-Joseph C, Bach BR (2015) Bioabsorbable versus metallic interference screws in anterior cruciate ligament reconstruction: a systematic review of overlapping meta-analyses. Arthroscopy 31(3):561–568

    Article  PubMed  Google Scholar 

  21. Saccomanno MF, Shin JJ, Mascarenhas R, Haro M, Verma NN, Cole BJ, Bach BR Jr (2014) Clinical and functional outcomes after anterior cruciate ligament reconstruction using cortical button fixation versus transfemoral suspensory fixation: a systematic review of randomized controlled trials. Arthroscopy 30(11):1491–1498

    Article  PubMed  Google Scholar 

  22. Schindler OS (2012) Surgery for anterior cruciate ligament deficiency: a historical perspective. Knee Surg Sports Traumatol Arthrosc 20(1):5–47

    Article  PubMed  Google Scholar 

  23. Speziali A, Delcogliano M, Placella G, Bartoli M, Menghi A, Cerulli G (2014) Fixation techniques for the anterior cruciate ligament reconstruction: early follow-up. A systematic review of level I and II therapeutic studies. Musculoskelet Surg 98(3):179–187

    Article  PubMed  Google Scholar 

  24. Zeng C, Gao SG, Li H, Yang T, Luo W, Li YS, Lei GH (2014) Autograft versus allograft in anterior cruciate ligament reconstruction: a meta-analysis of randomized controlled trials and systematic review of overlapping systematic reviews. Arthroscopy 32(1):153–163

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital of Bern, Freiburgstrasse, Bern, Switzerland

    Sufian S. Ahmad, Johannes C. Meyer, Anna M. Krismer, Dimitrios S. Evangelopoulos, Sven Hoppe & Sandro Kohl

  2. School of Medicine, University of Buckingham, Hunter Street, Buckingham, UK

    Suhaib S. Ahmad

Authors
  1. Sufian S. Ahmad
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  2. Johannes C. Meyer
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  3. Anna M. Krismer
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  4. Suhaib S. Ahmad
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  5. Dimitrios S. Evangelopoulos
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  6. Sven Hoppe
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  7. Sandro Kohl
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Corresponding author

Correspondence to Sufian S. Ahmad.

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The authors declare that they have no conflict of interest.

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No funding was received for the conduction of this study.

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For this type of study, formal consent is not required.

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Ahmad, S.S., Meyer, J.C., Krismer, A.M. et al. Outcome measures in clinical ACL studies: an analysis of highly cited level I trials. Knee Surg Sports Traumatol Arthrosc 25, 1517–1527 (2017). https://doi.org/10.1007/s00167-016-4334-4

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  • DOI: https://doi.org/10.1007/s00167-016-4334-4

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