Sports Medicine Research: In the Lab & In the Field: For Better or Worse: Predicting Quality of Life After an ACL Injury (Sports Med Res)
Wednesday, May 6, 2015

For Better or Worse: Predicting Quality of Life After an ACL Injury

Baseline Predictors of Health-Related Quality of Life After Anterior Cruciate Ligament Reconstruction

Dunn WR, Wolf BR, Harrell FE, Reinke EK, Huston LJ, and Spinder KP. J Bone Joint Surg. 2015. [Epub Ahead of Print].

Take Home Message: Smoking and fewer years of education are predictive of poor mental and physical health 2 or 6 years after an anterior cruciate ligament reconstruction. Higher activity levels, younger age, better quality of life before surgery, and lower body mass index at the time of injury, were all associated with higher quality of life scores at 2 or 6 years post-surgery.

Anterior cruciate ligament (ACL) injury is common among physically active individuals and can often lead to long-term disability. Currently, only limited information concerning predictive factors of quality of life following an ACL reconstruction exists. If we knew predictors of quality of life after an ACL reconstruction this could help us advise patients, improve surgeon decision-making, and identify factors that we could target when treating an ACL injury. Therefore, Dunn and colleagues completed a prospective cohort study to determine the predictors of quality of life at 2 and 6 years post-ACL reconstruction. The authors used data from 1,411 patients who underwent a unilateral ACL reconstruction between 2002 and 2004 at 1 of the 6 Multicenter Orthopedic Outcome Network (MOON) Knee Group sites. All patients completed the Short Form-36 (SF-36), which is a measure of general health (quality of life), before surgery, 2 years post-surgery, and 6 years post-surgery. The SF-36 provides a mental component summary score and physical component summary score. Surgeons completed an extensive survey to document intra-articular pathologies, treatments, and surgical techniques. Patients followed a standardized rehabilitation protocol. Better physical health at 2 or 6 years after surgery was related to better physical health at baseline, younger age, lower baseline body mass index, and having either >50% of the lateral meniscus excised or no lateral meniscus treatment. Better mental health at 2 or 6 years after surgery was related to better mental health at baseline and higher activity rating scale score. A history of being a smoker and fewer number of years of education were factors for both poor mental and physical health.

The data presented in this study offers insight into the factors associated with quality of life following an ACL reconstruction. Overall, the data suggests that those who are younger, highly physically active at the time of injury, and have better baseline mental and physical health should have the highest quality of life following surgery. More important for future research though is how can those patients with predictors of lower quality of life scores, be treated to improve their overall quality of life? For example, if a patient reports being a smoker, would more clinician-patient interaction mitigate the effects that smoking has and help improve their overall quality of life during the follow-up period? Furthermore, this study may suggest that we should strive to promote mental and physical health prior to surgery. Until more data and interventions can be studied, clinicians should be aware of these factors. Clinicians who identify patients with factors associated with lower quality of life after surgery should monitor the patient more closely, and may even wish to coordinate with other members of their sports medicine team to limit the negative effects the injury may have on their quality of life.

Questions for Discussion: How do you maintain or improve an athlete's quality of life following injury? Are there other factors which may influence this quality of life that you have experienced in your clinical practice?

Written by: Kyle Harris
Reviewed by:  Jeffrey Driban

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Dunn WR, Wolf BR, Harrell FE Jr, Reinke EK, Huston LJ, MOON Knee Group, & Spindler KP (2015). Baseline predictors of health-related quality of life after anterior cruciate ligament reconstruction: a longitudinal analysis of a multicenter cohort at two and six years. The Journal of Bone and Joint Surgery. American Volume, 97 (7), 551-7 PMID: 25834079

2 comments:

Caroline Lisee said...

This article brings up a good point that we need to look beyond physical rehabilitation after an ACLR at both factors influencing a patients outcome in the short term and long term. One of the greatest and easiest ways you can improve a patients quality of life is through education, but it's not enough anymore to to focus on the aspects immediately after the surgery or when they're in your care. As health care providers we need to talk about patient outcomes in the long run especially for younger kids and their parents. Sitting down with your patients, providing this information, and answering any question they may have is easy, but imperative. There is a lot of research focusing on ways to return patients to activities and prevent ACL re-injuries by assessing biomechanics, but as stated in this article it would be also be beneficial to study specific ways to improve overall quality of life after ACLR.

Kyle said...

Caroline,

I could not agree with you more. Your sentiment is something I too feel strongly about. It is difficult though. As athletic trainers we only work with athletes for 3-5 years on average. Personally, the data surrounding long-term disease and its progression is shocking and really warrants professions like athletic training to take a close look at how prepared we are to deal with early intervention of chronic disease like osteoarthritis. In your experiences, have you remained an open source of information following the athlete's discharge from your care?

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