Return to sport and quality of life in people with knee symptoms 5–20 years following anterior cruciate ligament reconstruction

Abstract

Introduction:Anterior cruciate ligament reconstruction (ACLR) can result in psychological and physical impairments that impact on participation in desired activities and sports. To date, no study has explored the impact of sports restrictions on quality of life (QOL) in people with knee symptoms following ACLR. The aims of this study were to (i) quantify QOL; and (ii) explore relationships between participant characteristics, sport-related factors and QOL 5–20 years following ACLR. Methods: We conducted a cross-sectional analysis on 139 individuals with knee pain, stiffness or activity limitations 5–20 years following ACLR. Participants were recruited from surgical records of four experienced orthopaedic surgeons. All patients aged 18–55 years who had a hamstring or patellar-tendon autograft ACLR 5–20 years ago were invited to participate. People with significant comorbidities and those not fluent in English were excluded. Participants completed the Anterior Cruciate Ligament QOL Questionnaire (ACL-QOL), Knee injury andOsteoarthritis Outcome Score (KOOS) and a demographics questionnaire. KOOS and ACL-QOL scores range from 0 (worst) to 100 (best). KOOS cut-off criteria were applied to ensure all participants were symptomatic. Spearman rank correlations explored relationships between participant characteristics, return to sports information and QOL. Results: A total of 139 participants completed the questionnaires at a mean 9 years (range 5–20) following ACLR. Participants had a mean age of 38 years (range 20–55), a mean BMI of 27 (range 19–43) and 42% were female. Participants scored a mean 55±20on theKOOS-QOL subscale and57±21on theACL-QOL. The most impaired ACL-QOL itemswere sport/recreational frustrations (33±31), playing sport under caution (36±35) and fear of contact sports (35±37). The least impaired ACL-QOL subscale was workrelated concerns (78±22). Returning to sport at a lower level (27%) or not returning to sport (34%) was correlated with poor KOOSQOL scores (r=0.32, p<0.01). Reporting the knee as the reason for not returning to the same level of sport (77%) was correlated with competitive needs not being met (r=0.25, p=0.01) and poor knee confidence (r=0.20, p=0.05). Pain-free sport or exercise participation was considered preferable (78%) to pain-free participation in work (2%), family (15%) or social activities (5%). Discussion: The ability to participate in sport and exercise appear to be a high priority and is associatedwith QOL impairment in peoplewith knee symptoms 5–20 years after ACLR. Knee-related QOL was considerably lower than population norms. Addressing knee confidence, sport-related concerns, frustrations and fearsmay assist in improving QOL following ACLR.