{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T05:48:33Z","timestamp":1794030513225,"version":"4.8.0"},"reference-count":54,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T00:00:00Z","timestamp":1735776000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Patient-reported outcome (PROs) instruments of knee function quality of life are routinely administered to patients after anterior cruciate ligament reconstruction (ACLR). The Patient Acceptable Symptom State (PASS), an evidence-based threshold defining perceived outcomes, may be a useful indicator of strength and functional performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To compare strength and functional performance between patients recovering from ACLR who did and did not meet PASS thresholds on associated PROs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cross-sectional study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A total of 223 patients who had undergone ACLR (106 women, 117 men; 7.62 \u00b1 1.71 months after ACLR) completed isokinetic knee extensor and flexor strength at 90 deg\/s, hop performance (single-limb hop for distance [SLHD], triple hop for distance [THD], 6-m timed hop [6MH]), and PROs (International Knee Documentation Committee Subjective Form [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], and Anterior Cruciate Ligament Return to Sport After Injury [ACL-RSI]) assessments in a controlled laboratory setting at an academic institution. Independent-samples\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      tests compared strength and hop measures between patients who did and did not achieve a PASS on the PROs. Limb symmetry index (LSI) was calculated as (ACLR Limb \u00f7 Contralateral Limb) \u00d7 100%. Strength and hop performance LSI outcomes were converted into indicator variables, categorized as either a \u201cpass\u201d or \u201cfail\u201d based on the operational definition of having an LSI value \u226590%. Chi-square tests compared strength and hop LSI PASS status measures to PRO PASS status.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Patients who achieved IKDC\n                      <jats:sub>PASS<\/jats:sub>\n                      were significantly stronger and had more symmetric limbs than those who did not achieve IKDC\n                      <jats:sub>PASS<\/jats:sub>\n                      . Values for IKDC\n                      <jats:sub>PASS<\/jats:sub>\n                      were as follows: knee extension ACLR limb 1.72 \u00b1 0.47 N\u00b7m\/kg, contralateral limb 2.40 \u00b1 0.45 N\u00b7m\/kg, LSI 71.64% \u00b1 15.23%; knee flexion ACLR limb 1.04 \u00b1 0.29 N\u00b7m\/kg, contralateral limb 1.05 \u00b1 0.26 N\u00b7m\/kg, LSI 99.12% \u00b1 17.22%. Values for IKDC\n                      <jats:sub>FAIL<\/jats:sub>\n                      were knee extension ACLR limb 1.47 \u00b1 0.52 N\u00b7m\/kg, contralateral limb 2.25 \u00b1 0.47 N\u00b7m\/kg, LSI 64.66% \u00b1 17.07%; knee flexion ACLR limb 0.88 \u00b1 0.28 N\u00b7m\/kg, contralateral limb 0.97 \u00b1 0.28 N\u00b7m\/kg, LSI 90.46% \u00b1 17.41%. Effect sizes ranged from small to moderate (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001;\n                      <jats:italic toggle=\"yes\">d<\/jats:italic>\n                      = 0.3-0.55). IKDC\n                      <jats:sub>PASS<\/jats:sub>\n                      status was significantly associated with an LSI \u226590% for knee flexion peak torque (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      = 9.66;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .002), SLHD (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      = 9.61;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .002), and THD (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      = 3.97;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .02), with a moderate effect size (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05;\n                      <jats:italic toggle=\"yes\">d<\/jats:italic>\n                      = 0.41-0.73). Significant relationships were found with KOOS\n                      <jats:sub>PASS<\/jats:sub>\n                      (Pain, Activities of Daily Living [ADL], and Sport) and LSI \u226590% for peak knee flexion torque with a moderate effect size (Pain and ADL,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001; Sport,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .04;\n                      <jats:italic toggle=\"yes\">d<\/jats:italic>\n                      = 0.59-0.72) and SLHD with a strong effect size for the Symptom subscale (Symptom,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .01,\n                      <jats:italic toggle=\"yes\">d<\/jats:italic>\n                      = 1.21; Pain,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .003; ADL,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .04; Sport,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .001). No differences were found in strength outcomes for patients who achieved ACL-RSI\n                      <jats:sub>PASS<\/jats:sub>\n                      versus those who did not (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; .05). Patients who achieved ACL-RSI\n                      <jats:sub>PASS<\/jats:sub>\n                      had more symmetric SLHD and THD LSI scores and jumped farther on their contralateral limb for the THD compared with ACL-RSI\n                      <jats:sub>FAIL<\/jats:sub>\n                      patients (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05;\n                      <jats:italic toggle=\"yes\">d<\/jats:italic>\n                      = 0.50-0.64).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      Patients meeting thresholds for the IKDC\n                      <jats:sub>PASS<\/jats:sub>\n                      and KOOS\n                      <jats:sub>PASS<\/jats:sub>\n                      (Pain, ADL, and Sport subscales) demonstrated greater knee strength bilaterally, and hopped farther and more symmetrically, compared with patients who scored below the PASS threshold on the same PROs. Using PASS thresholds for PROs can aid clinicians when considering when patients can safely return to activities after ACLR.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465241298917","type":"journal-article","created":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T08:59:08Z","timestamp":1735808348000},"page":"299-307","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["The Clinical Significance of Using PASS Thresholds When Administering Patient-Reported Outcome Instruments After Anterior Cruciate Ligament Reconstruction"],"prefix":"10.1177","volume":"53","author":[{"given":"Julian","family":"Mobley","sequence":"first","affiliation":[{"name":"University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devin 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