Abstract
BackgroundHealth-related quality of life (HRQoL) in anterior cruciate ligament (ACL) insufficiency has not been assessed in comorbid-free patients to date. An observational study was therefore conducted on a practice-based sample to test the hypothesis that SF-36 scoring in patients with chronic ACL insufficiency differs from the age- and gender-matched Italian norm.Materials and methodsChronically ACL-insufficient patients with or without meniscal and/or focal chondral lesions were enrolled in the study. Exclusion criteria were acute ACL tear, severe and diffuse chondral lesions, concomitant knee major ligamentous injuries and/or fractures requiring surgery, previous ACL surgery and infectious, neoplastic and inflammatory disease. Knee function was evaluated by International Knee Documentation Committee (IKDC) form, HRQoL with the SF-36 questionnaire, and associated medical comorbidities by a Self-Administered Comorbidity Questionnaire (SCQ).ResultsA total of 316 consecutive patients, 265 males and 51 females (median age 25 years, range 15–52 years) met the inclusion/exclusion criteria. SF-36 norm-based scoring showed that the Physical Functioning, Role Physical, Bodily Pain, and Social Functioning domains were significantly lower than the Italian norm; the Role Emotional domain was also lower than the norm, but the difference was not significant. Conversely, the General Health and Mental Health domains scored significantly higher than the norm; the Vitality domain also exceeded, albeit not significantly, the norm.ConclusionsThe decision-making process leading to ACL reconstruction currently emphasises the evaluation of knee function and patients’ level of activity. The findings in our study, by showing that chronic ACL insufficiency significantly affects HRQoL in otherwise healthy patients, suggest that a multidimensional evaluation including HRQoL in addition to knee function might be integrated into outcome assessment.
Highlights
The natural history of anterior cruciate ligament (ACL) insufficiency is unclear [1, 2], it is generally agreed that recurrent episodes of symptomatic instability would lead to an accrual of joint damage [1, 3], if meniscectomy has been performed [4]
SF-36 norm-based scoring showed that the Physical Functioning, Role Physical, Bodily Pain, and Social Functioning domains were significantly lower than the Italian norm; the Role Emotional domain was lower than the norm, but the difference was not significant
The findings in our study, by showing that chronic ACL insufficiency significantly affects Health-related quality of life (HRQoL) in otherwise healthy patients, suggest that a multidimensional evaluation including HRQoL in addition to knee function might be integrated into outcome assessment
Summary
The natural history of anterior cruciate ligament (ACL) insufficiency is unclear [1, 2], it is generally agreed that recurrent episodes of symptomatic instability would lead to an accrual of joint damage [1, 3], if meniscectomy has been performed [4]. We have assessed HRQoL using the SF-36 in comorbid-free recreational athletes with chronic ACL insufficiency undergoing arthroscopic reconstruction with the purpose of setting a normative HRQoL profile from a single surgeon’s practice to be compared with the age- and gender-matched Italian norm. This may prove useful in clarifying the true impact of ACL insufficiency on HRQoL of candidates for surgery, at the same time yielding normative data that could be used in future studies to investigate whether SF-36 profiles vary across practices. Knee function was evaluated by International Knee Documentation Committee (IKDC) form, HRQoL with the SF-36 questionnaire, and associated medical comorbidities by a Self-Administered Comorbidity Questionnaire (SCQ)
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