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Background <p>After an anterior cruciate ligament (ACL) rupture, characteristics of patients that may benefit from having ACL reconstruction (ACLR) versus undergoing non-surgical treatment are still largely not known. Identifying patient subgroups may help clinicians and researchers better understand the unique needs of individuals within common clinical profiles. The primary aim of this study was to identify subgroups of patients with an ACL injury, based on patient characteristics, psychological and social factors, and the extent of the initial injury, and to evaluate subgroup characteristics based on undergoing ACLR versus non-surgical management. The secondary aim was to compare subgroups on their knee function and return to sports outcomes.</p> Results <p>A total of 275 participants (age 15–40, 48% male) with an acute ACL injury treated with usual care, either ACLR or not, from the Natural Corollaries and Recovery after ACL injury (NACOX) multicenter longitudinal cohort study were included. At two years after injury, 169 (62%) had undergone ACLR. The analysis uncovered 3 latent classes (entropy = 0.91, Akaike’s information criterion (AIC) = 12125.2, Bayesian information criteria (BIC) = 12302.4, sample size adjusted BIC = 12147.0, Vuong-Lo-Mendell-Rubin (VLMR) likelihood ratio test=-6085.8, VLMR p-value = 0.5). Participants in Class 2 (<i>n</i> = 155) had 1.8 times (hazards ratio (HR):1.814, 95% confidence interval (CI) 1.293–2.545, <i>p</i> &lt; 0.001) higher probability for having an ACLR compared to Class 3 (<i>n</i> = 98). There were no statistically significant differences in patient reported knee function (International Knee Documentation Committee (IKDC) score) at one- or two-years follow-up between the classes. A higher proportion of participants in Class 3 returned to same or higher activity level compared to Class 1 (<i>n</i> = 22) and 2.</p> Conclusions <p>The three distinct subgroups of patients after ACL rupture differed in probability to undergo ACLR and return to activity after injury at one and two years after injury. There was no difference between subgroups in patient-reported knee function at one or two years after injury. Clinicians should consider the differentiating characteristics between subgroups along with the goals of their patients when engaging in shared decision-making about surgical or nonsurgical management.</p>

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Identification of characteristics of patients who choose operative versus non-operative management after ACL injury: a latent class analysis

  • 期刊论文

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  • 发表日期：

    2025年11月5日

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  • Elanna K. Arhos,
  • Joanna Kvist

摘要

Background

After an anterior cruciate ligament (ACL) rupture, characteristics of patients that may benefit from having ACL reconstruction (ACLR) versus undergoing non-surgical treatment are still largely not known. Identifying patient subgroups may help clinicians and researchers better understand the unique needs of individuals within common clinical profiles. The primary aim of this study was to identify subgroups of patients with an ACL injury, based on patient characteristics, psychological and social factors, and the extent of the initial injury, and to evaluate subgroup characteristics based on undergoing ACLR versus non-surgical management. The secondary aim was to compare subgroups on their knee function and return to sports outcomes.

Results

A total of 275 participants (age 15–40, 48% male) with an acute ACL injury treated with usual care, either ACLR or not, from the Natural Corollaries and Recovery after ACL injury (NACOX) multicenter longitudinal cohort study were included. At two years after injury, 169 (62%) had undergone ACLR. The analysis uncovered 3 latent classes (entropy = 0.91, Akaike’s information criterion (AIC) = 12125.2, Bayesian information criteria (BIC) = 12302.4, sample size adjusted BIC = 12147.0, Vuong-Lo-Mendell-Rubin (VLMR) likelihood ratio test=-6085.8, VLMR p-value = 0.5). Participants in Class 2 (n = 155) had 1.8 times (hazards ratio (HR):1.814, 95% confidence interval (CI) 1.293–2.545, p < 0.001) higher probability for having an ACLR compared to Class 3 (n = 98). There were no statistically significant differences in patient reported knee function (International Knee Documentation Committee (IKDC) score) at one- or two-years follow-up between the classes. A higher proportion of participants in Class 3 returned to same or higher activity level compared to Class 1 (n = 22) and 2.

Conclusions

The three distinct subgroups of patients after ACL rupture differed in probability to undergo ACLR and return to activity after injury at one and two years after injury. There was no difference between subgroups in patient-reported knee function at one or two years after injury. Clinicians should consider the differentiating characteristics between subgroups along with the goals of their patients when engaging in shared decision-making about surgical or nonsurgical management.