Understanding the Factors that Influence Decision-Making Regarding Management of ACL Injuries: A UK, Australian and Canadian-Based Delphi Study
Bibliographic record
Abstract
Aims: As public health systems change and engagement in sport competition grows, this study aims to build on previous research to establish expert consensus on aspects of ACL injury management, focussing on elite athletes and those impacted by lengthening surgical waiting lists. The study also aims to explore key factors that experts consider when determining ACL injury management. Methods: 22 specialist knee surgeons completed a 3-round Delphi Study consisting of 20 questions - consensus was set at 75% agreement. Round I was created based on an evidence review. Rounds II and III were identical and based on expert feedback from Round I. Wilcoxon signed rank test and Kendall’s W assessed the level of agreement between rounds and among participants, respectively. Key results: 32% believe rehabilitation-only is a viable option for elite athletes. 100% agreed rehabilitation has a greater re-injury risk than ACL-R. 86% agreed the decision for surgery can change if successful rehabilitation is completed whilst on the waiting list. Concomitant injuries was considered the most important factor. Only 50% of experts feel confident referring for rehabilitation-only management. Consensus was not reached on inclusion of lateral extra-articular procedures and secondary complications. Kendall’s W indicated moderate agreement in Round II (W = 0.532, p < 0.001) and stronger agreement in Round III (W = 0.672, p < 0.001), confirming convergence of expert consensus. Most items showed stable responses between rounds using. The Wilcoxon ranked test indicated individual participant’s responses were consistent across rounds (p = 0.16 to 1.00). Conclusions: Rehabilitation-only is not recommended for elite athletes or athletes in twisting / pivoting sports. For non-elite athletes who are on a waiting list for surgery, extensive rehabilitation should be prioritised, and re-assessment prior to their surgery is crucial, as successful rehabilitation can alter the decision for surgery. The presence of concomitant injuries is the most important factor when determining ACL injury management. Further research is required on the graft choice, lateral extra-articular procedures and impact of secondary complications.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".