Guideline on anterior cruciate ligament injury

Figures & data

Table 2. Level of evidence of the conclusion

Level of evidence	Interventional studies	Diagnostic accuracy studies	Harm, side effects, etiology, prognosis
A1	Systematic review/meta-analysis of at least 2 independently conducted studies of A2 level.
A2	Randomized, double blind trial with good study quality and an adequate number of study participants.	Index test compared to reference test (reference standard); cut-offs were defined a-priori; independent interpretation of test results; an adequate number of consecutive patients were enrolled; all patients received both tests.	Prospective cohort study of sufficient magnitude and follow-up, adequately controlled for “confounding” and no selective follow-up.
B	Clinical trial, but without all the features mentioned for level A2 (including case-control study, cohort study).	Index test compared to reference test, but without all the features mentioned for level A2.	Prospective cohort study, but without all the features mentioned for level A2 or retrospective cohort study or case-control study.
C	Non-comparative studies.
D	Expert opinion.

Table 3. Level of evidence of the conclusion

Level	Conclusion based on:
1	A1 study or at least 2 independent studies of level A2.
2	1 study of level A2 or at least 2 independent studies of level B.
3	1 study of level B or C.
4	Expert opinion.

Table 4. Internal indicators for ACL injury

Type of indicator	Operationalization
Structural	Is the KOOS and/or IKDC subjective used in the treatment process?
Process	What is the percentage of patients registered with an outcome scored with KOOS and/or IKDC?
Structural	Is there a protocol for MRI, based on the ACL guideline, that indicates when imaging is necessary?
Structural	Is there a rehabilitation protocol encompassing sensomotoric training, open- and closed-chain strength training, and optimization of range of motion?
Structural	Has the rehabilitation protocol been updated at least every 3 years?
Outcome	What is the median time between the occurrence of the ACL insufficiency and the operation?
Process	What is the percentage of patients who have been operated on within a year of the ACL insufficiency occurring?