Sports Medicine Research: In the Lab & In the Field: Return to Sport and BMI are Associated with Quality of Life After an ACL Reconstruction (Sports Med Res)
Wednesday, June 15, 2016

Return to Sport and BMI are Associated with Quality of Life After an ACL Reconstruction

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

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Filbay, S., Ackerman, I., Russell, T., & Crossley, K. (2016). Return to sport matters-longer-term quality of life after ACL reconstruction in people with knee difficulties Scandinavian Journal of Medicine & Science in Sports DOI: 10.1111/sms.12698

6 comments:

Unknown said...

I think this article really puts into perspective the importance of returning to sport or play at any level of competition. Regardless if the athlete or patient returns to their original level of competition, this article shows that their is a correlation between returning to some level of sport participation and the quality of life post ACLr. We have a duty as clinicians to look out for the quality of life of our athletes and patients.
In regards to BMI and quality of life, I think that is a universal problem, inside and outside the world of athletics. In particular to athletics, athletes are used to being a certain size or shape for competition and the loss of both the ability to compete and the shape of competition may have a dual impact on them psychologically impacting their quality of life post ACLr if they are unable to return to sport and they are left in their new shape and fitness. Eye opening article.

KellyMartinUVA said...

This article demonstrates an interesting correlation with both BMI and return to sport in relation to quality of life. I think that it is necessary to consider psychological factors after an ACL injury in addition to strength, neuromuscular deficits, etc. If the ACL injury is career ending, and the player may not return to sport - that may have an effect on both the quality if life and potential weight gain. To many athletes, their sport is their identity. After such an injury, it may be hard for them to cope. This was definitely an interesting read.

Kyle said...

I think both commentators have really identified the source of the issue that lies at the heart of the clinical implications of this study. We can all agree that returning to some level of activity is critical. This can be important for psychological reasons as well as maintaining BMI. I think the larger discussion needs to be what is the athletic trainer's role in this? Should it be part of our role to discuss long-term implications and play a role in reintroducing injured athletes to activity despite their inabilities to reach preinjury activity levels? If so, are we currently equipped as healthcare professionals to do this?

Haley said...

I fully believe that identity is a huge aspect of sports. When an individual gets injured, they lose this identity, which can lead to lower quality of life. Athletic trainers should be encouraging a return to sport if they know this can lead to poor outcomes.
I believe we should be educating our athletes on weight management as part of their rehabilitation and should work with other groups of the sports medicine team to improve the patient's quality of life.

Jeffrey Driban said...

Haley, I think you bring up a good point about working with other groups of the sports medicine team. For our athletes may not be able to return to play b/c they don't fully recover or because they graduate before they are cleared to play it may be helpful to have them meet with a sports psychologist about coping strategies. We can all help them find their new identity. I think in general we need to be doing more to promote the long-term wellness of our patients.

Kyle said...

Haley,

I love your comment on athlete identity. This is something a mentor of mine was particularly interested in studying as it pertained to career ending injury. I would add that with an increasing number of athletes specializing in a particular sport for much of their athletic career, this can increase this association between sport and identity. I strongly believe that all clinicians should have some level of understanding of this identify issue and be prepared to identify signs that this identify may be in crisis so an appropriate recommendation can be made. Again, great comments.

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