Satisfaction With Knee Function After Primary Anterior Cruciate Ligament Reconstruction Is Associated With Self-Efficacy, Quality of Life, and Returning to the Preinjury Physical Activity

Abstract

Purpose: To assess whether patient-reported outcomes (psychological factors, appraisals of knee function, and physical activity participation) were associated with satisfaction with knee function after anterior cruciate ligament (ACL) reconstruction. Methods: Participants who were aged 18 to 45 years and a minimum 12 months post primary ACL reconstruction completed a questionnaire battery evaluating knee self-efficacy, knee-related quality of life, self-reported function, and physical activity participation. Participants responses to the question "If you were to spend the rest of your life with your knee just the way it has been in the last week, would you feel.... (7-point ordinal scale; 1 = happy, 7 = unhappy)" were categorized as satisfied, mostly satisfied, or dissatisfied and used as the primary outcome. Ordinal regression was used to examine associations between independent variables and the primary outcome. Results: A total of 177 participants were included at an average of 3 years after primary ACL reconstruction. At follow-up, 44% reported they would be satisfied, 28% mostly satisfied, and 28% dissatisfied with the outcome of ACL reconstruction. There were significant differences in psychological responses and appraisal of knee function between the 3 groups (P = .001), and significantly more people in the satisfied group had returned to their preinjury activity (58%) than in the mostly satisfied (28%) and dissatisfied (26%) groups (P = .001). Multivariable analysis demonstrated that the odds of being satisfied increased by a factor of 3 with higher self-efficacy, greater knee-related quality of life, and returning to the preinjury activity. Conclusions: People who had returned to their preinjury physical activity and who reported higher knee-related self-efficacy and quality of life were more likely to be satisfied with the outcome of ACL reconstruction

Objectively Measured Physical Activity in Patients After Anterior Cruciate Ligament Reconstruction

“…3,18,19,23,47,49 Unfortunately, objectively measured physical activity has not been utilized as an outcome measure in this population, despite the potential role that physical activity has in the prevention of chronic diseases as well as improving health-related quality of life. 3 While aspects of physical activity such as return to sport 22,23,42 or peak current physical activity level 3,47 have been prospectively described in patients with a history of ACLR, these outcome measures are not structured appropriately to objectively assess the critical characteristics of physical activity as presented in the FITT (frequency, intensity, time, and type) principle, which is the current gold-standard approach for the quantification of physical activity. 20,32 Furthermore, current recommendations from a number of national organizations 14,24 for maintaining a physically active lifestyle or a healthy level of physical activity include frequency, time, and intensity components, which are not sufficiently assessed using traditional measures in the ACLR literature such as the Marx activity rating scale or the Tegner activity level scale.…”

Poor functional performance 1 year after ACL reconstruction increases the risk of early osteoarthritis progression

“…Due to the multifactorial fluctuating nature of life for a young active adult, it is likely many other subjective factors influence change in KOOS and IKDC scores, hence predicting PROs post-ACLR is challenging 16 52. Further research should consider potential psychosocial and contextual influences on PROs such as fear avoidance, confidence, coping and healthcare utilisation 53–57…”

Every athlete has a unique trajectory: Knee-related quality of life in young athletes following anterior cruciate ligament reconstruction

“…[24] Similar to physical activity, RTS has been shown to be positively associated with knee-related QOL, [29] despite evidence that not all individuals with satisfactory QOL actually RTS. [30,31] Similar to knee symptoms, physical activity, and kinesiophobia, the relationship between RTS and health-and kneerelated QOL is complex and not well understood.…”