Knee Injury and Osteoarthritis Outcome Score (KOOS) Responder Criteria and Minimal Detectable Change 3-12 Years Following a Youth Sport-Related Knee Injury.

Clodagh M Toomey,Jackie L Whittaker,Carolyn A Emery,Luz Palacios-Derflingher

doi:10.3390/jcm10030522

Abstract

The applicability of thresholds that constitute an acceptable score or meaningful change on the Knee injury and Osteoarthritis Outcome Score (KOOS) in cohorts ≥ 5 years following knee injury is not well understood. The primary objective of this study was to evaluate the association between intra-articular knee injury type and two different KOOS pain thresholds (patient acceptable symptom state (PASS) and Englund symptomatic knee criteria) in the Alberta Youth Prevention of Osteoarthritis (PrE-OA) cohort, which includes participants 3–12 years following a youth sport-related knee injury and uninjured controls with similar age, sex and sport characteristics. Analyses accounted for sex, time since injury and the interaction between time since injury and injury type. Secondary objectives were to report proportions meeting thresholds for KOOS outcomes and minimal detectable change (MDC) from published test–retest reliability data, over a 1–4-year follow-up. Two hundred and fifty-three (253) participants (124 injured, 129 controls) were included in analyses, of which 153 (77 injured, 76 controls) had follow-up data. Similar odds were observed for presence of pain (below PASS threshold) in participants with anterior cruciate ligament (ACL)/meniscus injury (odds ratio (OR) 4.2 (97.5% confidence interval (CI): 1.8, 9.9)) and other knee injuries (OR 4.9 (97.5% CI: 1.2, 21.0)), while there were higher odds for presence of Englund “symptomatic knee” criteria in participants with ACL/meniscus injury (OR 13.6 (97.5% CI: 2.9, 63.4)) than other knee injuries (OR 7.3 (97.5% CI: 0.8, 63.7)) compared to controls. After a median 23.4 (8 to 42) month follow-up, 35% of previously injured participants had at least one KOOS sub-scale score that worsened by more than the MDC published threshold. Despite limited research, this study shows that individuals with youth sport knee injuries other than ACL or meniscus injury may also experience significant pain and symptoms 3–12 years following injury. Replication and further follow-up are needed to identify a possible clinical trajectory towards osteoarthritis.

Highlights

Much sport medicine and musculoskeletal health research has focused on rehabilitation and recovery following an anterior cruciate ligament (ACL) injury due to the immediate and long-term effects on activity participation and health
The final dataset was comprised of 253 participants (124 previously injured participants (n = 89 ACL and/or meniscal injury and n = 35 other knee injury) and 129 uninjured controls)
The results of this study suggest that other sub-groups of injury may carry a high risk for a painful or symptomatic knee requiring medical attention

Summary

Introduction

Much sport medicine and musculoskeletal health research has focused on rehabilitation and recovery following an anterior cruciate ligament (ACL) injury due to the immediate and long-term effects on activity participation and health. Of foremost concern is the higher likelihood of development of knee joint osteoarthritis (OA) after sustaining an ACL or other traumatic intra-articular knee injury [6], sentencing a proportion of these individuals to a lifetime of knee pain, symptoms, reduced function and quality of life (QOL). Of these patient-reported outcomes (PRO), knee pain is the most common symptom of OA [7], but defining what constitutes clinically significant pain is not well-understood in individuals following injury and prior to onset of potential joint disease.

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Conclusion