Prospective analysis of health-related quality of life and clinical evaluations in patients with anterior cruciate ligament injury undergoing reconstruction

Abstract

This study aimed to evaluate the treatment outcome of patients with anterior cruciate ligament (ACL) injury using the patient-based quality of life (QOL) survey SF-36, and investigate the correlation with conventional objective assessment methods. Our hypothesis that SF-36 is a useful assessment method for QOL in patients with ACL injury, and this assessment clarifies the concord and the discord between doctor-based objective assessment. A prospective study was conducted on patients who underwent ligament reconstruction. Eighty-one patients with a mean age of 27.4years were analyzed. Clinical evaluations comprising SF-36 survey, Lysholm scoring, and anterior tibial translation measurement were conducted before as well as after surgery. The changes over time and the correlation between these evaluation methods were analyzed. All SF-36 subscales were significantly improved after surgery. Regarding QOL of patients with ACL injury, the preoperative scores of all the subscales except vitality and mental health were lower than the national standard values, while the postoperative scores of all subclasses were not different from the national standards. A correlation was found between Lysholm score and all SF-36 subscale scores except general health before surgery, but a correlation was observed only with physical functioning, bodily pain and role emotional at 6months after surgery, and with physical functioning, role physical, bodily pain and vitality at 12months. No correlation between SF-36 scores and distance of anterior tibial translation was observed both before and after surgery. The QOL of patients with ACL injury as assessed by SF-36 improved significantly after reconstruction surgery. The mental health subscales of SF-36 correlate with Lysholm score before surgery suggesting that apart from the physical impairment, lowered mental health is also an important clinical issue in patients with ACL injury.