Return to sport matters – longer-term quality of life after ACL reconstruction in people with knee difficulties.
Filbay SR., Ackerman IN, Russell TG, and Crossley KM. Scand J Med Sci Sports. 2016. [Epub Ahead of Print].
Take Home Message: Lower overall quality of life after an anterior cruciate ligament (ACL) reconstruction was associated with higher body mass index (BMI) and not returning to sport.
Despite new techniques to treat an ACL rupture, many patients report long-term impairments in quality of life. Clinicians could provide care to reduce the risk of poor outcomes if clinicians knew which factors related to poor long-term outcomes. Hence, Filbay and colleagues completed a cross-sectional study to identify the factors related to quality of life 5 to 20 years after ACL reconstruction. The authors included 162 patients who spoke English and between the ages of 18 and 55 years. They excluded someone if the patient reported a comorbidity likely to impact their quality of life, underwent ACL reconstruction within the past 5 years, or were asymptomatic according to the Knee Injury and Osteoarthritis Score (KOOS). All patients completed a demographic questionnaire, the KOOS, Assessment of Quality of Life 8D Utility Instrument, the Anterior Cruciate Ligament Quality of Life Questionnaire, the Workplace Activity Limitations Scale (assesses work limitations), and the Hospital Anxiety and Depression Scale (assesses psychological heath). The operational definition of quality of life for the current study was defined as, “the degree that an individual’s [quality of life] is impacted by knee-related factors.” Questionnaires were completed ~9 years post-surgery and the most common activities at the time of injury were netball (20%), soccer (16%), rugby (11%), and Australian rules football (11%). Sixty-three (39%) of participants returned to competitive sport while 46 (28%) returned at a lower level, and 32% did not return to sport. Overall, higher BMI, subsequent surgery, and not returning to sport were associated with lower overall quality of life scores.
Overall, the authors found that returning to sport was associated with better quality of life scores than those who returned to any level of sport. It’s difficult to say why the 32% did not return to sport. Some may have been unable to return while others may have been close to retirement already. However, it is alarming that not returning to sports was a factor that led to lower quality of life. This could suggest that those patients who were able to return to sport were able to cope better with the surgery and the rehabilitation than those that did not return to sport. This was not the focus of the study and should be investigated further to truly understand how return to sport affects quality of life. Also of note, but not necessarily surprising was the association between higher BMI and lower quality of life. Literature detailing the association between BMI and lower return to sport rates are abundant. This is still important for clinicians because controlling BMI is important for many long-term factors, which affect quality of life such as the development of osteoarthritis. A prior study highlighted that a 15 pound or more weight gain after an ACL reconstruction is associated with poor outcomes. Overall, the data in this study may help clinicians in a number of areas. Firstly, these results may help clinicians begin to develop more targeted rehabilitation and treatment strategies for ACL reconstruction. Further, if clinicians are aware of these factors, they may be able to work proactively with their athletes to control body weight before and after surgery and when necessary refer athletes to other members of the sports medicine team to get more specific treatment (e.g. sport psychologist, nutritionist). All of these factors could be implemented by clinicians to better serve these athletes.
Questions for Discussion: Do you counsel patients on weight management after knee surgery? Do you feel that your athletes who return to the same level of activity, cope better with the surgery and rehabilitation than those who do not?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban