Dynamic evolution of evaluation standards for effectiveness and safety after anterior cruciate ligament reconstruction in the knee

Li Chengke; Gao Miaomiao; Lei Lei; Ma Rongxing; Zhang Jingyu; Hu Yongcheng

doi:10.12307/2026.769

Abstract：BACKGROUND:A combination of subjective and objective evaluation criteria is often required to more accurately and comprehensively assess knee function in patients undergoing anterior cruciate ligament reconstruction. OBJECTIVE:To review the evolving trends in effectiveness and safety evaluation criteria after anterior cruciate ligament reconstruction and analyze the dynamic shift in the use of subjective and objective assessment tools. METHODS:A systematic search of PubMed and Embase was conducted up to August 22,2023 to identify studies assessing knee function after anterior cruciate ligament reconstruction.A total of 136 eligible studies meeting the inclusion criteria were included.The frequency of each evaluation standard was extracted and analyzed over time using Origin 2025 software. RESULTS AND CONCLUSION:(1)Between 1990 and 2005,objective measures were widely applied.Since 2005,subjective scoring systems,particularly patient-reported outcome measures,have increased sharply,surpassing objective standards in frequency from 2009 onward.(2)Early use was dominated by the Lysholm scale and Tegner activity score,while the International Knee Documentation Committee-Subjective Knee Form,Knee Injury and Osteoarthritis Outcome Score,and anterior cruciate ligament-return to sport after injury gradually emerged as the main tools in later years.(3)In contrast,objective assessments such as the KT1000/2000 arthrometer,Lachman test,and hop tests remained relatively stable but showed an overall downward trend.(4)This suggests that the evaluation criteria for the effectiveness and safety of anterior cruciate ligament reconstruction have shifted from a primary focus on objective knee stability to an emphasis on patient-reported experiences.(5)This study is the first to quantitatively reveal the dynamic evolution of mainstream assessment tools.Current clinical practice highlights the integration of subjective and objective measures,and we recommend the following combination:International Knee Documentation Committee-Subjective Knee Form or Knee Injury and Osteoarthritis Outcome Score,together with anterior cruciate ligament-return to sport after injury,plus either the KT1000/2000 arthrometer or hop tests.Such a framework provides a more comprehensive reflection of both functional recovery and patient perception,offering an evidence-based foundation for the development of future integrated evaluation systems.