Quality of life in anterior cruciate ligament-deficient individuals: a systematic review and meta-analysis.
Filbay SR, Culvenor AG, Ackerman IN, Russell TG, and Crossley KM. Br J Sports Med. 2015. 49:1033-1041.
Take Home Message: A systematic review of 11 studies revealed that patients who either received anterior cruciate ligament (ACL) reconstruction or remained deficient (ACL-D) reported lower quality of life than the general healthy population.
After an ACL injury many patients fail to return to the same level of sport competition, develop early-onset osteoarthritis, and have a fear of reinjury – all of which could contribute to a decreased quality of life years after an injury. By better understanding the long-term outcomes, clinicians can identify best practices and better understand what treatment options are best for certain patients. Therefore, Filbay and colleagues completed a systematic review and meta-analysis to report the quality of life among patients who are ACL-deficient (ACL-D) between 5 and 25 year post-injury. The researchers also sought to compare quality of life among patients who are ACL-D, patients who had an ACL reconstruction, and the general population. After a systematic search of online databases the researchers included articles if the study participants, (1) completed a quality-of-life measure, (2) had not received a reconstruction, and (3) were on average 18 to 55 years of age at the time of follow-up. The Downs and Black Checklist was modified and used to gauge methodological quality. Overall, the researchers initially identified 1,172 articles, which they narrowed down to 11 studies after applying the inclusion and exclusion criteria. Overall study quality ranged from 11 to 21 points out of a total possible 21 points. Quality-of-life outcomes were available for 473 patients who were ACL-D. Eight studies measured knee-related quality of life with the Knee Injury Osteoarthritis Outcome Score (KOOS) and reported scores ranging from 54 to 77 out of a possible 100 points (higher is better). Patients who were ACL-D had lower knee-related quality of life than those reported in a general population (~81 out of 100). The authors found no difference in knee-related quality of life between patients who were ACL-D or those who an ACL reconstruction. Knee-related quality of life was not related to the length of follow-up since surgery. Patients who were ACL-D had a similar health-related quality of life than the general population but their scores were impaired compared with a more physically active population (college athletes).
Overall, the current study is important because it demonstrates that patients with an ACL injury, regardless of whether they receive an ACL reconstruction, reported impaired quality of life at 5 to 25 years after injury. This is particularly true for quality of life as it relates to knee symptoms and function. It is critical that clinicians recognize that this population is at risk for reporting an impaired quality of life within a few years of injury. For example, if a college athlete tears his/her ACL then before turning 30 the athlete is likely to complain of reduced quality of life and will be burdened for over half a lifetime. Clinicians need to use this data to counsel patients following an ACL rupture and throughout the rehabilitation process. Clinicians may specifically wish to consider discussing strategies for prolonging patient’s joint health such as weight control strategies. This will introduce patients to concepts that may help protect the joint from further stress, which could accelerate joint degeneration and lead to further declines in quality of life. Until, specific strategies and patient guidelines are developed to protect long-term joint health, clinicians should continue to counsel patients on all potential future impacts that the injury may have on quality of life. We have an obligation to our patients to provide them with the information they need to make informed decisions about their joint health.
Questions for Discussion: Do you feel this study will impact your current counseling and education approach to athletes who sustain an ACL rupture? Do you feel athletes who sustain an ACL rupture would base their treatment decision on long-term quality of life or more immediate joint stability?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
ACL Graft Type May Not Matter When Attempting to Improve Patient-Reported Outcome 2-Years Post-Surgery