Return to sport matters—longer‐term quality of life after ACL reconstruction in people with knee difficulties

Abstract

Many individuals experience long-term quality of life (QOL) impairment following anterior cruciate ligament reconstruction (ACLR). Factors contributing to poor QOL and psychological health >5 years after ACLR remain unclear. This study aimed to describe QOL and psychological health outcomes in people with knee difficulties (pain, symptoms, or functional limitations) 5-20 years following ACLR and identify factors explaining variability in these outcomes. Participants with knee difficulties 5-20 years following ACLR completed a battery of validated patient-reported outcomes [including the Knee injury and Osteoarthritis Outcome Score (KOOS), ACL-QOL, and the Assessment of QOL (AQoL-8D) instrument]. Multivariable linear regression was used to identify factors explaining variability in outcomes. One hundred sixty-two participants aged 38 ± 9 (mean ± SD) years completed questionnaires 9 ± 4 (range 5-20) years following ACLR. Thirty-nine percent of participants returned to competitive sport, 28% returned to a lower level, and 32% did not return to sport after ACLR. Not returning to sport after ACLR was associated with worse KOOS-QOL (β = 0.29, P = 0.001 [mean ± SD (55 ± 20)], ACL-QOL [β = 0.48, P < 0.001; (57 ± 21)], and AQoL-8D [β = 0.22, P = 0.02 (0.80 ± 0.14)]) scores. Increased body mass index (56% were overweight/obese) was related to worse QOL and more depressive symptoms. Subsequent knee surgery and contralateral ACLR were also associated with poorer QOL outcomes in these individuals.

Return to pivoting sport after ACL reconstruction: association with osteoarthritis and knee function at the 15-year follow-up

“…Even though larger group differences were seen for the other KOOS subscale values, the CIs were wider than for KOOS ADL, which may explain the lack of statistically significant differences. Filbay et al 39 reported that subjects who returned to competitive sport at the same or higher level had 12 points higher knee-related quality of life score compared with those who did not return to sport 5–20 years after the ACLR. The greater difference observed by Filbay et al may relate to their inclusion of ACLR patients with knee pain and symptoms, and with shorter follow-up time, which would result in a different sample from the present study.…”

Association between MRI-defined osteoarthritis, pain, function and strength 3–10 years following knee joint injury in youth sport

“…Further, due to the limited number of persons with MRI-defined OA, the current analyses could not assess the interaction between injury history and MRI-defined OA; therefore, although both appear to impact knee-related quality of life independently, their additive effect 3–10 years following a youth sport-related knee injury remains unknown. Other factors that may contribute to knee-related quality of life include the ability to return to sport and subsequent and contralateral knee surgery 17. Accordingly, future investigations aimed at further elucidating the relationship between knee-related quality of life and MRI-defined OA following sport-related knee injury should aim for a larger sample size that enable multivariable analyses with more sophisticated models that consider the interaction of injury history and MRI-defined OA and other potential explanatory factors.…”

Longer-term quality of life following ACL injury and reconstruction

“…Following this, 162 people with knee difficulties 5–20 years after ACL reconstruction completed a range of patient-reported measures (including four QOL measures) 4. Regression analysis was used to identify factors explaining variability in QOL.…”