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Published on: March 1, 2024
There is no such thing like a single ACL injury: Profiles of ACL-injured patients
1Sports Clinic, clinique d'Eich, Academic Teaching Hospital of the Saarland University Medical Centre, centre hospitalier de Luxembourg, 76, rue d'Eich, 1460 Luxembourg, Luxembourg; Sports Medicine Research Laboratory, Luxembourg Institute of Health, 76, rue d'Eich, 1460 Luxembourg, Luxembourg; Cartilage Net of the Greater Region Saar-Lor-Lux, Luxembourg, Luxembourg.
Insights
This study identified distinct patient subtypes for anterior cruciate ligament (ACL) injuries, revealing that treatment decisions for ACL reconstruction vary significantly based on age, gender, and activity level. Understanding these profiles aids in personalized treatment and injury prevention.
Area of Science:
- Orthopedics
- Sports Medicine
- Biostatistics
Background:
- Current anterior cruciate ligament (ACL) registries often exclude non-operatively treated patients, leading to an incomplete understanding of the ACL-injured population.
- This study aimed to characterize the patient population and treatment decisions within an intrahospital registry.
- Hypotheses included the identification of patient-specific subtypes and variations in surgical treatment rates among them.
Purpose of the Study:
- To identify distinct patient subtypes within an ACL-injured population.
- To analyze the factors influencing treatment decisions (surgical vs. non-surgical) for ACL injuries.
- To establish a basis for individualized treatment approaches and improved risk assessment for ACL injuries.
Main Methods:
- Inclusion of 346 operated and non-operated patients from March 2011 to December 2013.
- Data collection via standardized questionnaires on demographics, sports participation, and injury history.
- Statistical analysis including chi-square tests and cluster analysis to identify patient profiles.
Main Results:
- Three age groups were defined: ≤20, 21-35, and ≥36 years.
- Injury patterns varied by gender and age group; males (21-35) and females (≥36) showed distinct injury trends.
- Surgical treatment rates exceeded 80% for competitive athletes under 35, decreased to 60-80% for non-competitive athletes, and were below 60% for patients over 35.
Conclusions:
- Systematic data collection enabled the identification of specific ACL injury subtypes based on key patient characteristics.
- Treatment decisions for ACL reconstruction were significantly influenced by these identified patient characteristics.
- These findings support an individualized treatment strategy and enhance the understanding of risk factors for ACL injuries.
Background:
Current ACL registries rarely include non-operatively treated patients thus delivering an incomplete picture of the ACL-injured population. The aim of this study was to get an image of the population and treatment decision of an intrahospital registry. Our hypotheses were that patient-specific subtypes can be identified and that the percentage of operated patients differs between them.
Material And Methods:
Three hundred and forty-six operated and non-operated patients were included from March 2011 to December 2013. Standardized questionnaires allowed for data collection on gender, age, sports practice and previous ACL injuries. Chi-square tests allowed to compare these parameters between genders and age groups. A cluster analysis was computed to determine profiles of patients with similar characteristics.
Results:
Three age groups were considered (I: ≤20; II: 21-35; III: ≥36 years). For males, the highest frequency of injuries was noted in group II with a greater proportion of injuries compared to females. In group III, more females were injured than males. Before injury, 54% patients were involved in competitive sports. Males were more likely to be injured in pivoting/contact sports before 35 and females during recreational skiing after 35. Twenty-one percent of the patients had had a previous ACL injury. The percentage of surgical treatment was superior to 80% in patients under 35 years involved in competitive sports, of 60-80% for those not involved in competitive sports and inferior to 60% for patients above 35 years.
Discussion:
Systematic data collection allowed to identify specific subtypes of ACL-injured patient according to gender, age, previous ACL injury and preinjury level of practice. The decision-making process for or against ACL reconstructions at time of presentation depended on these characteristics. Consideration of these parameters will serve as a basis for an individualized treatment approach and a better understanding of patients at risk for ACL injuries.
Level Of Evidence:
III.
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