Which PROM Should Be Used to Address the Right Domain of Interest After ACL-R: A Comprehensive Review

TL;DR

This paper reviews which patient-reported outcome measures (PROMs) are best for evaluating specific domains like quality of life or psychological readiness after ACL reconstruction.

Contribution

The paper provides a comprehensive review and domain-specific guidance for selecting the most appropriate PROMs after ACL-R.

Findings

ACL-QOL is best for quality-of-life assessments, while ACL-RSI is most robust for psychological readiness.

IKDC and KOOS show strong reliability for knee symptoms and function, with KOOS offering broader subscale coverage.

Brief tools like SANE and EQ-5D provide rapid assessments but lack depth, and some PROMs show ceiling/floor effects depending on recovery stage.

Abstract

Patient-reported outcome measures (PROMs) are essential for evaluating symptoms, function, psychological readiness, and quality of life after anterior cruciate ligament reconstruction (ACL-R). Despite their broad use, PROMs differ considerably in what they measure and how well they perform. This comprehensive review summarizes evidence for the most commonly used PROMs in ACL-R and provides guidance on selecting instruments that best match a given domain of interest.

A targeted PubMed search (January 2000–October 2025), complemented by manual screening of references, identified studies reporting psychometric properties of ACL-related PROMs. Extracted data included internal consistency, test–retest reliability, SEM/MDC, MCID, responsiveness, ceiling/floor effects, patient burden, cross-cultural validation, and conceptual domains.

PROMs varied widely in scope and measurement quality. ACL-QOL consistently demonstrated excellent reliability and is well suited for ACL-specific quality-of-life assessments. ACL-RSI is the most robust tool for psychological readiness to return to sport. IKDC and KOOS showed strong reliability for general knee symptoms and function, with KOOS offering broader subscale coverage. KOS-ADLS performed well for activities of daily living, while VAS provided a reliable single-domain pain measurement. WOMAC showed strong psychometrics in osteoarthritis but limited relevance in younger athletic populations. Brief tools such as SANE, EQ-5D, and the Tegner scale offer rapid global assessment but lack depth. Several instruments showed ceiling or floor effects depending on recovery stage and activity level.

No single PROM captures all dimensions relevant after ACL-R. Domain-driven selection—such as ACL-QOL for QoL, ACL-RSI for psychological factors, IKDC/KOOS for function, or VAS for pain—ensures meaningful assessment. Considering measurement precision (SEM/MDC/MCID) and adhering to COSMIN principles can improve the comparability and clinical utility of ACL outcomes research.