Kay M. Crossley, BPhysio(Hons Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072, Australia.
Am J Sports Med. 2014 May;42(5):1247-55. doi: 10.1177/0363546513512774. Epub 2013 Dec 6.
Anterior cruciate ligament reconstructions (ACLRs) are frequently performed on young, active patients and can result in persistent knee symptoms and activity limitations that may affect health-related quality of life (HRQoL). To date, there has been no systematic review of HRQoL outcomes after ACLR.
The objectives of this study were to report HRQoL ≥5 years after ACLR, compare HRQoL outcomes with available population norms, and describe factors that may affect HRQoL in this population.
Systematic review.
All studies reporting HRQoL ≥5 years after ACLR with hamstring or patellar tendon autografts were eligible for review. Common HRQoL outcomes were pooled using a random-effects meta-analysis and compared with published population norms. The Spearman rank correlation coefficient (ρ) was used to identify variables associated with HRQoL outcomes. Where insufficient data were available, outcomes were reported descriptively.
Fourteen studies were eligible for review, and HRQoL was reported for 2493 patients at a mean of 9 years (range, 5-16 years) after ACLR. Pooling of knee-related quality of life outcomes (Knee injury and Osteoarthritis Outcome Score [KOOS]-QOL) found impairments after ACLR when compared with population norms. In comparison, studies using the Short Form-36 (SF-36) reported similar or better HRQoL compared with normative data. The KOOS-QOL subscores correlated strongly with KOOS-sport/recreation (ρ = .70, P = .04) and KOOS-pain (ρ = .85, P = .003) subscores. Severe radiographic osteoarthritis, meniscal injuries sustained after surgery, and revision ACLR were associated with poorer HRQoL outcomes at a minimum 5-year follow-up. The negative influence of concomitant meniscal surgery on HRQoL became apparent more than 10 years after ACLR.
This review found that patients assessed using a knee-specific measure (KOOS-QOL) were more likely to report poorer HRQoL values, compared with population norms, than those assessed using a generic HRQoL measure (SF-36). Revision surgeries, meniscal injuries, and severe radiographic osteoarthritis were associated with poorer HRQoL outcomes after ACLR. However, these relationships should be interpreted with caution, as they were only investigated in a small number of studies.
These results can be used by clinicians to educate patients about potential long-term outcomes after ACLR and to develop strategies for optimizing postoperative HRQoL.
前交叉韧带重建（ACLR）常应用于年轻、活跃的患者，可能导致持续的膝关节症状和活动受限，从而影响健康相关生活质量（HRQoL）。迄今为止，尚无 ACLR 后 HRQoL 的系统评价。
本研究旨在报告 ACLR 后 5 年以上的 HRQoL，与可获得的人群正常值进行比较，并描述可能影响该人群 HRQoL 的因素。
系统评价。
所有报告 ACLR 后 5 年以上使用腘绳肌腱或髌腱自体移植物的 HRQoL 的研究均符合纳入标准。使用随机效应荟萃分析汇总常见的 HRQoL 结果，并与已发表的人群正常值进行比较。使用斯皮尔曼等级相关系数（ρ）来确定与 HRQoL 结果相关的变量。对于数据不足的情况，报告描述性结果。
共有 14 项研究符合纳入标准，2493 例患者在 ACLR 后平均 9 年（5-16 年）时报告了 HRQoL。与人群正常值相比，膝关节相关生活质量（KOOS 健康问卷-生活质量 [KOOS-QOL]）的结果发现存在损伤。相比之下，使用 36 项简短健康调查量表（SF-36）的研究报告的 HRQoL 与正常值相似或更好。KOOS-QOL 亚量表与 KOOS-运动/娱乐（ρ=.70，P=.04）和 KOOS-疼痛（ρ=.85，P=.003）亚量表具有很强的相关性。在至少 5 年的随访中，严重的放射学骨关节炎、手术后半月板损伤和 ACLR 翻修与较差的 HRQoL 结果相关。ACL 重建后 10 年以上，伴随半月板手术对 HRQoL 的负面影响变得明显。
本研究发现，使用膝关节特异性测量（KOOS-QOL）评估的患者比使用一般 HRQoL 测量（SF-36）评估的患者更有可能报告较差的 HRQoL 值，与人群正常值相比。翻修手术、半月板损伤和严重的放射学骨关节炎与 ACLR 后较差的 HRQoL 结果相关。然而，由于这些关系仅在少数研究中进行了调查，因此应谨慎解释这些结果。
这些结果可用于指导临床医生向 ACLR 后患者讲解潜在的长期结果，并制定优化术后 HRQoL 的策略。
