Long-term quality of life, work limitation, physical activity, economic cost and disease burden following ACL and meniscal injury: a systematic review and meta-analysis for the OPTIKNEE consensus

Abstract

ObjectiveDetermine the long-term health-related quality-of-life (HRQoL), work limitation, physical activity, health/economic cost and disease burden of traumatic ACL and/or meniscal injury. Findings will inform OPTIKNEE evidence-based consensus recommendations.DesignRandom-effects meta-analysis evaluated HRQoL (SF-36/SF-12/VR-12 Physical Component Scores (PCS) and Mental Component Scores (MCS), EuroQol-5D (EQ-5D)) stratified by time postinjury, and pooled mean differences (95% CI) between ACL-injured and uninjured controls. Other outcomes were synthesised descriptively. Risk-of-bias (RoB) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) were assessed.Data sourcesMEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched inception: 22 November 2021.EligibilityStudies reporting HRQoL, work limitations, physical activity levels, health/economic costs or disease burden, ≥2 years post-ACL and/or meniscal injury.ResultsFifty studies were included (10 high-RoB, 28 susceptible-to-some-bias and 12 low-RoB). Meta-analysis (27 studies, very low certainty of evidence) estimated a pooled mean (95% CI) PCS of 52.4 (51.4 to 53.4) and MCS of 54.0 (53.0 to 55.0) 2–14 years post-ACL injury. Pooled PCS scores were worse >10 years (50.8 (48.7 to 52.9)) compared with 2–5 years (53.9 (53.1 to 54.7)) postinjury. Excluding high-RoB studies, PCS scores were worse in ACL-injured compared with uninjured controls (−1.5 (−2.9 to –0.1)). Six studies (low certainty of evidence) informed a pooled EQ-5D score of 0.83 (0.81 to 0.84). Some individuals experienced prolonged work absenteeism and modified activities ≥2 years post-ACL injury. ACL injury was associated with significant direct and indirect costs, and early ACL reconstruction may be less cost-effective than rehabilitation. Only three studies evaluated meniscal injury outcomes (all evaluated HRQoL).ConclusionThere is a very-low certainty of evidence that PCS scores ≥2 years post-ACL injury are worse than uninjured controls and decline over time, whereas MCS scores remain high. ACL injury can result in prolonged work absenteeism and high health/economic costs. Further studies are needed to determine the long-term burden of traumatic meniscal injury.

OPTIKNEE 2022: consensus recommendations to optimise knee health after traumatic knee injury to prevent osteoarthritis

“…15 16 Due to their relatively young injury age, people with traumatic knee injuries develop OA at an earlier age than to those without injuries, leading to more years lived with disability. 17 Knowing that traumatic injuries precipitate knee OA presents an opportunity to prevent (delay or halt) OA. This opportunity hinges on knowing who develops post-traumatic OA (PTOA; target population), when and how to intervene (target treatments), and what are the most important outcomes and methods to assess them.…”

Evidence of ACL healing on MRI following ACL rupture treated with rehabilitation alone may be associated with better patient-reported outcomes: a secondary analysis from the KANON trial

“…Interestingly, people in the healed ACL group underwent a mean 33 rehabilitation sessions, compared with 45, 76 and 63 sessions in the non-healed, delayed ACLR and early ACLR groups, respectively. Early ACLR is not cost-effective compared with rehabilitation and optional delayed ACLR for acute ACL rupture 43. Future research should investigate whether people with ACL healing on MRI have reduced healthcare costs and shorter work absenteeism, compared with people with a non-healed ACL and those undergoing early or delayed ACLR.…”

Patients that maintain their pre-injury level of physical activity 3–5 years after ACL reconstruction are, 18 months after surgery, characterised by higher levels of readiness to return to sport

“…However, as these patients, at group level, had a high pre-injury level of PA, reflected by the Tegner, as well as the fact that the majority of patients stated that they were involved in some sort of organised PA before their injury, the proportion of physically inactive individuals must be regarded as too high. To better understand the PA habits of patients after ACL reconstruction and compare the proportions of patients involved in different types and frequencies of PA, a prospective cohort study with a sufficient number of patients using PROs in combination with device-based assessment approaches appears to be necessary [ 15 , 21 ].…”

“…A severe knee injury, such as an injury to the anterior cruciate ligament (ACL), often entails a period of reduced frequency and intensity of PA and a change in the type of PA [ 15 ]. Historically, ACL injury research has mainly focused on aspects of returning patients to sport, which has also been used as an outcome of successful treatment [ 1 ].…”