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.

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

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