Quality
of life in anterior cruciate ligament-deficient individuals: a systematic
review and meta-analysis.
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.
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.
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).
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.
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?
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
Related Posts:
Filbay, S., Culvenor, A., Ackerman, I., Russell, T., & Crossley, K. (2015). Quality of life in anterior cruciate ligament-deficient individuals: a systematic review and meta-analysis British Journal of Sports Medicine, 49 (16), 1033-1041 DOI: 10.1136/bjsports-2015-094864
I think this is a great review to do to show that even though you could have a reconstruction or just be ACL-D, you will still be lacking quality of life. Clinicians should be aware of this and should be able to educate their patient so that they are aware that they will most likely not be the same as they were before the injury. Patients hear stories about extremely successful athletes who come back and play just as they did prior to the injury but these can be outliers. Clinicians need to motivate during the rehab process but also be aware that education in quality of life is a main factor during rehab
Ryan,
I could not agree with you analysis more. So much focus can be on the return to play that if we don't take the time to educate our patients we could be doing them a disservice. Thanks for the comment!
I believe that this review hit the nail right on the head. Often times clinician's values and the patient's values do not align or are not recognized. Often times the clinician will draw comparisons to high class athletes when in reality, the other 99.99% of the population are not at that level and simply want to be functional for ADLs. I think too often we as clinicians are looking more at the short term like returning to play and ignoring or overlooking the future quality of life. I believe that it is important to educate the patient that they will never be back to their true pre-injury status. They can be close, but never 100% back to "normal." I think aligning goals and being realistic with expectations would improve or at least temper the outcomes of individuals.
Steven,
Well said. I agree that the realignment of clinician and patient values needs to happen. You also touched on the idea that to some extent this is setting specific as you will deal with varying levels of athletes in different settings. Perhaps having a conversation with the clinicians in your workplace or others in similar settings can be a good start to see this gap narrow. Thanks for the comment!