PATIENT-REPORTED AND FUNCTIONAL OUTCOMES FOLLOWING ANTERIOR CRUCIATE LIGAMENT INJURIES: A RETROSPECTIVE REVIEW OF ESCALATED CARE PATHWAYS

Introduction ACL injuries in New Zealand (NZ) account for 80% of knee ligament surgeries, with most of the surgeries and rehabilitation funded by ACC. Due to increasing costs in 2020 ACC proposed a new way of working called Escalated Care Pathways (ECP) to develop innovative changes to the current management of significant musculoskeletal conditions in particular ACL. The objective of this pilot scheme was to improve management, return to work, equity, access to surgery, and more effective rehabilitation. Aims To analyse and quantify the Patient Reported Outcome Measures (PROMS) and functional measures in patients enrolled in the Careway ACL patient group. Methods The Knee Osteoarthritis Outcome Score (KOOS), Limb Symmetry Index (LSI), demographic information, number of physiotherapists visits and overall duration of treatment was collected from January 2021 to December 2003. Results Data from 750 patients (surgical: n = 332 (43%), mean age 33.1 ± 13.1 years, non-surgical: n = 418, (55.7%) mean age of 36.1 ± 15.1 years, were analysed. Treatment duration was significantly longer in the surgical group (mean 317.2 ± 141.5 days) vs non-surgical group (280.2 ± 158.1 days) (p<0.01). Surgical patients had more physiotherapy visits (25.2 ± 19.6 vs. 13.1 ± 14.1, p<0.01). KOOS Score and LSI values improved in both groups. The change scores for KOOS surgical (29.07 SD 20.0) and non-surgical (25.8 SD 18.4) were not statistically significant (p=0.052). LSI scores increased from baseline to exit, (surgical: 77.25 ± 26.8 to 100.8 ± 29.7; non-surgical: 77.05 ± 36.3 to 104.7 ± 363.3) but were not statistically significant (p=0.051). Conclusion The study found that both surgical and non-surgical patients achieved positive outcomes upon exiting the pathway. The surgical group's average number of physiotherapy visits aligned closely with existing literature but were higher than current practices in New Zealand.