J Orthop Sports Phys Ther. 2018 May;48(5):398-408. doi: 10.2519/jospt.2018.7830. Epub 2018 Apr 18.
Study Design Clinical measurement, cross-sectional. Background Individuals who have undergone anterior cruciate ligament (ACL) reconstruction commonly experience long-term impairments in quality of life (QoL), which may be related to persistent knee symptoms or radiographic osteoarthritis (ROA). Understanding the impact of knee symptoms and ROA on QoL after ACL reconstruction may assist in the development of appropriate management strategies. Objectives To (1) compare QoL between groups of individuals after ACL reconstruction (including those who are symptomatic with ROA, symptomatic without ROA, and asymptomatic [unknown ROA status]), and (2) identify specific aspects of QoL impairment in symptomatic individuals with and without ROA post ACL reconstruction. Methods One hundred thirteen participants completed QoL measures (Knee injury and Osteoarthritis Outcome Score QoL subscale [KOOS-QoL], Anterior Cruciate Ligament Quality of Life [ACL-QoL], Assessment of Quality of Life-8 Dimensions [AQoL-8D]) 5 to 20 years after ACL reconstruction. Eighty-one symptomatic individuals underwent radiographs, and 32 asymptomatic individuals formed a comparison group. Radiographic osteoarthritis was defined as a Kellgren-Lawrence grade of 2 or greater for the tibiofemoral and/or patellofemoral joints. Mann-Whitney U tests compared outcomes between groups. Individual ACL-QoL items were used to explore specific aspects of QoL. Results In symptomatic individuals after ACL reconstruction, ROA was related to worse knee-related outcomes on the KOOS-QoL (median, 50; interquartile range [IQR], 38-69 versus median, 69; IQR, 56-81; P<.001) and the ACL-QoL (median, 51; IQR, 38-71 versus median, 66; IQR, 50-82; P = .04). The AQoL-8D scores showed that health-related QoL was impaired in both symptomatic groups compared to the asymptomatic group. The ACL-QoL item scores revealed greater limitations and concern surrounding sport and exercise and social/emotional difficulties in the symptomatic group with ROA. Conclusion Osteoarthritis is associated with worse knee-related QoL in symptomatic individuals after ACL reconstruction. Diagnosing ROA in symptomatic individuals after ACL reconstruction may be valuable, because these individuals may require unique management. Targeted strategies to facilitate participation in satisfying activities have potential to improve QoL in symptomatic people with ROA after ACL reconstruction. J Orthop Sports Phys Ther 2018;48(5):398-408. doi:10.2519/jospt.2018.7830.
临床测量，横断面研究。背景：接受前交叉韧带（ACL）重建的个体通常会长期存在生活质量（QoL）受损的情况，这可能与持续的膝关节症状或放射学骨关节炎（ROA）有关。了解 ACL 重建后膝关节症状和 ROA 对 QoL 的影响，可能有助于制定适当的管理策略。目的：（1）比较 ACL 重建后各组个体的 QoL（包括有 ROA 症状的个体、无 ROA 症状的个体和无症状的个体[未知 ROA 状态]）；（2）确定有和无 ROA 症状的 ACL 重建后个体中 QoL 受损的特定方面。方法：113 名参与者在 ACL 重建后 5 至 20 年完成了 QoL 测量（膝关节损伤和骨关节炎结果评分 QoL 子量表[KOOS-QoL]、前交叉韧带生活质量[ACL-QoL]、生活质量 8 维度评估[AQoL-8D]）。81 名有症状的个体接受了 X 线检查，32 名无症状的个体作为对照组。放射学骨关节炎的定义为胫股关节和/或髌股关节的 Kellgren-Lawrence 分级为 2 级或更高。曼-惠特尼 U 检验比较了各组的结果。使用 ACL-QoL 单项来探讨 QoL 的特定方面。结果：在 ACL 重建后的有症状个体中，ROA 与 KOOS-QoL（中位数，50；四分位距[IQR]，38-69 与中位数，69；IQR，56-81；P<.001）和 ACL-QoL（中位数，51；IQR，38-71 与中位数，66；IQR，50-82；P =.04）的膝关节相关结局更差有关。AQoL-8D 评分显示，与无症状组相比，两组有症状个体的健康相关 QoL 均受损。ACL-QoL 单项评分显示，有 ROA 症状的个体在运动和锻炼方面的限制和担忧更大，以及在社会/情绪方面的困难更大。结论：在 ACL 重建后的有症状个体中，OA 与膝关节相关 QoL 更差有关。在 ACL 重建后的有症状个体中诊断 ROA 可能很有价值，因为这些个体可能需要独特的管理。针对有 ROA 的有症状个体的有针对性的策略，有可能改善 ACL 重建后 ROA 患者的 QoL。
