Impact of treatment strategy and physical performance on future knee-related self-efficacy in individuals with ACL injury

Abstract

BackgroundIn people with anterior cruciate ligament (ACL) injury, high self-efficacy facilitates recovery, indicated by improved muscle function, reduced knee symptoms and increased physical activity. Impact of treatment on future self-efficacy is however not well investigated. The aims of the study were to 1) investigate knee-related self-efficacy 6 years after acute ACL injury in patients treated with exercise therapy alone or in combination with either early or the option of delayed ACL reconstruction (ACLR), and 2) to investigate associations between single-leg physical performance at various time points after ACL injury and knee self-efficacy at 6 years after injury.MethodsParticipants (n = 121) originated from the KANON-study (ISRCTN84752559), a treatment RCT including active adults with acute ACL injury treated with structured exercise therapy combined with early or the option of delayed ACLR. In this ancillary study, participants with knee self-efficacy data at 6 years (n = 89) were analyzed as treated; exercise therapy alone (n = 20), exercise therapy plus early ACLR (n = 46), and exercise therapy plus delayed ACLR (n = 23). The participants performed physical performance tests (hop, strength and balance) at the end the of exercise therapy (mean 10 (SD 6) months), and at 5 years, and rated their knee self-efficacy using Knee Self-Efficacy Scale (K-SES) questionnaire (0 to 10, worst to best) at 6 years.ResultsMedian K-SES score for the total group (n = 89) was 7.8 (IQR 5.9–9.0). There were no differences between treatment groups in K-SES scores at 6 years nor in physical performance at any time point (p ≥ 0.097). Worse knee flexion strength LSI (rsp = 0.341, p = 0.042) at the end of the exercise therapy, and worse LSI for single-leg hop test (rsp = 0.310, p = 0.005) at the end of the exercise therapy and at 5 years, correlated moderately with worse knee-related self-efficacy at 6 years. Low associations were observed between the remaining physical performance tests and K-SES scores (rsp ≤ 0.265, p ≥ 0.045).ConclusionKnee-related self-efficacy at 6 years after ACL injury did not differ between those treated with ACLR, performed early or as a delayed procedure, or exercise therapy alone. Good physical performance at the end of the exercise therapy, and at 5 years, appears to have a positive, yet small, impact on future knee-related self-efficacy.

Validation of an 18-item version of the Swedish Knee Self-Efficacy Scale for patients after ACL injury and ACL reconstruction

“…With regard to knee joint disorders, a positive association between greater self-efficacy and positive outcomes has been reported for patients with knee osteoarthritis [ 9 , 10 , 21 ], total joint arthroplasty [ 40 , 43 ], and meniscectomy [ 11 ]. To assess perceived knee-related self-efficacy in patients with ACL injury or reconstruction, the Knee Self-Efficacy Scale (K-SES) was developed in 2006 by Thomeé et al [ 35 ] The original version of the K-SES has been used by different research groups in Sweden [ 1 , 8 , 14 ] and has been cross-culturally adapted into Dutch [ 41 ] and English [ 12 ]. The original K-SES is used to identify patients with high self-efficacy as well as patients with low self-efficacy from early after ACL injury and ACL reconstruction up to 12 months thereafter.…”

A Systematic Review of Randomized Controlled Trials in Anterior Cruciate Ligament Reconstruction: Standard Techniques Are Comparable (299 Trials With 25,816 Patients)

“… Kiadaliri et al., 2016 43 Economic evaluation at 5 years Cost-effectiveness QALYs No significant differences between the groups. Flosadottir et al., 2018 48 at 6 years’ FU Knee Self-Efficacy Scale No significant differences between the groups Culvenor et al., 2019 44 Secondary analysis at 5 years’ FU PFJ cartilage loss MRI based Early ACLR group had significantly greater loss of patellar cartilage thickness compared with optional delayed ACLR. Same trial Eriksson et al., 2018 45 II ACLR within 8 days of injury vs delayed after normalized ROM 6-10 weeks after injury at 6 months’ FU (n = 70) Visual analog scale, ROM, IKDC, Stability No significant differences between the 2 groups, although less muscle atrophy in the early group compared with their contralateral side.…”

“…The remining 3 RCTs also reported no significant differences ( Table 4 ). 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 …”

“…The remining 3 RCTs also reported no significant differences (Table 4). [41][42][43][44][45][46][47][48][49][50][51]…”

Clinical Outcomes and Donor Site Morbidity of Anterior Cruciate Ligament Reconstruction with Full Thickness Peroneus Longus Tendon

“…Anterior cruciate ligament (ACL) is an important anatomical structure for maintaining the stability and moveability of a knee joint [1] , and the lengths of its collagen and elastic bers will change with the stress in it under a physiological load. When the load exceeds its strength, ACL will be damaged or broken, not only reducing the stability and moveability of the knee joint but also accelerating its degeneration [2] .…”