The Relationship of Knee-related Quality of Life With Function,Psychological Factors,Strength,Performance,and Postural Stability After ACL Reconstruction: A Cross-Sectional Study
Restricted accessResearch articleFirst published online March, 2023
The Relationship of Knee-related Quality of Life With Function,Psychological Factors,Strength,Performance,and Postural Stability After ACL Reconstruction: A Cross-Sectional Study
Patients after anterior cruciate ligament reconstruction (ACLR) have decreased health-related quality of life (QoL) compared with healthy control participants. Few studies have verified the predictors of QoL using Quality of Life Outcome Measure Questionnaire for Chronic Anterior Cruciate Ligament Deficiency (ACL-QoL), and no study has verified the relationship of psychological factors and knee function with ACL-QoL in patients after ACLR.
Hypothesis:
Knee functional status, muscle strength, performance in hop tests, postural stability, and psychological factors would be the predictors of QoL after ACLR.
Study Design:
Cross-sectional study.
Level of Evidence:
Level 4.
Methods:
A total of 131 participants who had undergone ACLR at least 6 months previously were evaluated. QoL was assessed using ACL-QoL; knee functional status, using International Knee Documentation Committee Subjective Knee (IKDC) and global rating scale (GRS); psychological readiness, using Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI); kinesiophobia, using Tampa Scale for Kinesiophobia (TSK-17); knee strength, using isokinetic dynamometer; performance, using single-leg hop tests; and postural stability, using Biodex Balance System. Pearson’s linear correlation and stepwise hierarchical multiple linear regression analyses were performed to verify the predictors of QoL.
Results:
ACL-QoL showed a moderate correlation with IKDC (r = 0.69), GRS (r = 0.55), ACL-RSI (r = 0.50), and TSK-17 (r = -0.49). ACL-QoL presented none to low correlations with the variables of muscle strength, postural stability, and performance in hop tests. The variables related to the knee functional status and psychological factors (IKDC, GRS, ACL-RSI, and TSK-17) were found to be the predictors of QoL (R2 = 0.56; P = 0.01).
Conclusion:
Knee functional status, psychological readiness, and kinesiophobia were the predictors of knee-related QoL in patients after ACLR.
Clinical Relevance:
These results can assist clinicians in the therapeutic monitoring of the factors that may interfere with QoL in patients after ACLR.
AhldénMSamuelssonKSernertNForssbladMKarlssonJKartusJ. The Swedish National Anterior Cruciate Ligament Register: a report on baseline variables and outcomes of surgery for almost 18,000 patients. Am J Sports Med. 2012;40:2230-2235.
2.
AlbanoTRRodriguesCASMeloAKPde PaulaPOAlmeidaGPL. Clinical decision algorithm associated with return to sport after anterior cruciate ligament reconstruction. J Athl Train. 2020;55:691-698.
3.
AlmeidaGPLAlbanoTRMeloAKP. Hand-held dynamometer identifies asymmetries in torque of the quadriceps muscle after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2019;27:2494-2501.
4.
AlmeidaGPLMonteiroIOMarizeiroDFMaiaLBLimaPOP. Y balance test has no correlation with the Stability Index of the Biodex Balance System. Musculoskelet Sci Pract. 2017;27:1–6.
5.
ArdernCLÖsterbergATagessonSGauffinHWebsterKEKvistJ. The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. Br J Sports Med. 2014;48:1613-1619.
6.
BareniusBNordlanderMPonzerSTidermarkJErikssonK. Quality of life and clinical outcome after anterior cruciate ligament reconstruction using patellar tendon graft or quadrupled semitendinosus graft: an 8-year follow-up of a randomized controlled trial [published correction appears in Am J Sports Med. 2011;39(4):NP6]. Am J Sports Med. 2010;38:1533-1541.
7.
BodkinSGSlaterLVNorteGEGoetschiusJHartJM. ACL reconstructed individuals do not demonstrate deficits in postural control as measured by single-leg balance. Gait Posture. 2018;66:296-299.
De Ste CroixMDeighanMArmstrongN. Assessment and interpretation of isokinetic muscle strength during growth and maturation. Sports Med. 2003;33:727-743.
10.
FerrariJDBachBRJrBush-JosephCAWangTBojchukJ. Anterior cruciate ligament reconstruction in men and women: an outcome analysis comparing gender. Arthroscopy. 2001;17:588-596.
11.
FilbaySRAckermanINRussellTGCrossleyKM. Return to sport matters—longer-term quality of life after ACL reconstruction in people with knee difficulties. Scand J Med Sci Sports. 2017;27:514-524.
12.
FilbaySRAckermanINRussellTGMacriEMCrossleyKM. Health-related quality of life after anterior cruciate ligament reconstruction: a systematic review. Am J Sports Med. 2014;42:1247-1255.
13.
FilbaySRCrossleyKMAckermanIN. Activity preferences, lifestyle modifications and re-injury fears influence longer-term quality of life in people with knee symptoms following anterior cruciate ligament reconstruction: a qualitative study. J Physiother. 2016;62:103-110.
14.
GarciaSAMoffitTJVakulaMNHolmesSCMontgomeryMMPamukoffDN. Quadriceps muscle size, quality, and strength and self-reported function in individuals with anterior cruciate ligament reconstruction. J Athl Train. 2020;55:246-254.
15.
GillTMFeinsteinAR. A critical appraisal of the quality of quality-of-life measurements. JAMA. 1994;272:619-626.
16.
HartHFCulvenorAGGuermaziACrossleyKM. Worse knee confidence, fear of movement, psychological readiness to return-to-sport and pain are associated with worse function after ACL reconstruction. Phys Ther Sport. 2020;41:1-8.
17.
HochJMSinnottCWRobinsonKPPerkinsWOHartmanJW. The examination of patient-reported outcomes and postural control measures in patients with and without a history of ACL reconstruction: a case control study. J Sport Rehabil. 2018;27:170-176.
18.
IrrgangJJSnyder-MacklerLWainnerRSFuFHHarnerCD. Development of a patient-reported measure of function of the knee. J Bone Joint Surg Am. 1998;80:1132-1145.
19.
JohnsonJLIrrgangJJRisbergMASnyder-MacklerL. Comparing the responsiveness of the global rating scale with legacy knee outcome scores: a Delaware-Oslo Cohort Study. Am J Sports Med. 2020;48:1953-1960.
20.
KvistJEkASporrstedtKGoodL. Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2005;13:393-397.
21.
MaltaMCardosoLOBastosFIMagnaniniMMFSilvaCMFP. Iniciativa STROBE: subsídios para a comunicação de estudos observacionais. Rev Saude Publica. 2010;44:559–65.
22.
MånssonOKartusJSernertN. Health-related quality of life after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2011;19:479-487.
23.
MetsavahtLLeporaceGRibertoMde Mello SpositoMMBatistaLA. Translation and cross-cultural adaptation of the Brazilian version of the International Knee Documentation Committee Subjective Knee Form: validity and reproducibility. Am J Sports Med. 2010;38:1894-1899.
24.
MöllerEWeidenhielmLWernerS. Outcome and knee-related quality of life after anterior cruciate ligament reconstruction: a long-term follow-up. Knee Surg Sports Traumatol Arthrosc. 2009;17:786-794.
25.
NegahbanHAhmadiPSalehiRMehravarMGoharpeyS. Attentional demands of postural control during single leg stance in patients with anterior cruciate ligament reconstruction. Neurosci Lett. 2013;556:118-123.
26.
NorteGESolaasHSalibaSAGoetschiusJSlaterLVHartJM. The relationships between kinesiophobia and clinical outcomes after ACL reconstruction differ by self-reported physical activity engagement. Phys Ther Sport. 2019;40:1-9.
27.
NovarettiJVFrancioziCEForgasASasakiPHInghamSJMAbdallaRJ. Quadriceps strength deficit at 6 months after ACL reconstruction does not predict return to preinjury sports level. Sports Health. 2018;10:266-271.
28.
NoyesFRBarberSDMangineRE. Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med. 1991;19:513-518.
29.
NúñezMSastreSNúñezELozanoLNicodemoCSegurJM. Health-related quality of life and direct costs in patients with anterior cruciate ligament injury: single-bundle versus double-bundle reconstruction in a low-demand cohort—a randomized trial with 2 years of follow-up. Arthroscopy. 2012;28:929-935.
30.
OttSMIrelandMLBallantyneBTWillsonJDMcClay DavisIS. Comparison of outcomes between males and females after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2003;11:75-80.
31.
PattersonBCulvenorAGBartonCJ, et al. Poor functional performance 1 year after ACL reconstruction increases the risk of early osteoarthritis progression. Br J Sports Med. 2020;54:546-553.
32.
PaulDJNassisGP. Testing strength and power in soccer players: the application of conventional and traditional methods of assessment. J Strength Cond Res. 2015;29:1748-1758.
33.
PiussiRBeischerSThomeéRHamrin SenorskiE. Hop tests and psychological PROs provide a demanding and clinician-friendly RTS assessment of patients after ACL reconstruction, a registry study. BMC Sports Sci Med Rehabil. 2020;12:32.
34.
PottkotterKADi StasiSLSchmittLC, et al. Improvements in thigh strength symmetry are modestly correlated with changes in self-reported function after anterior cruciate ligament reconstruction. Orthop J Sports Med. 2018;6:2325967118807459.
35.
PuaYHBryantALSteeleJRNewtonRUWrigleyTV. Isokinetic dynamometry in anterior cruciate ligament injury and reconstruction. Ann Acad Med Singap. 2008;37:330-340.
36.
RoeCJacobsCKlineP, et al. Correlations of single-leg performance tests to patient-reported outcomes after primary anterior cruciate ligament reconstruction. Clin J Sport Med. 2021;31:e265-e270.
37.
RoosEMLohmanderLS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64.
38.
RossMDLangfordBWhelanPJ. Test-retest reliability of 4 single-leg horizontal hop tests. J Strength Cond Res. 2002;16:617-622.
39.
SalavatiMMoghadamMEbrahimiIArabAM. Changes in postural stability with fatigue of lower extremity frontal and sagittal plane movers. Gait Posture. 2007;26:214-218.
40.
Sánchez RomeroEALimTAlonso PérezJLCastaldoMMartínez LozanoPVillafañeJH. Identifying clinical and MRI characteristics associated with quality of life in patients with anterior cruciate ligament injury: prognostic factors for long-term. Int J Environ Res Public Health. 2021;18:12845.
41.
SandersTLMaradit KremersHBryanAJ, et al. Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. Am J Sports Med. 2016;44:1502-1507.
42.
SchmitzRArnoldB. Intertester and intratester reliability of a dynamic balance protocol using the biodex stability system. J Sport Rehabil. 1998; 7: 95-101.
43.
SilvaLOMendesLMRLimaPOPAlmeidaGPL. Translation, cross-adaptation and measurement properties of the Brazilian version of the ACL-RSI Scale and ACL-QoL Questionnaire in patients with anterior cruciate ligament reconstruction. Braz J Phys Ther. 2018;22:127-134.
44.
SiqueiraFTeixeira-SalmelaMagalhãesLL. Análise Das Propriedades Psicométricas Da Versão Brasileira da Escala Tampa De Cinesiofobia. Acta Ortop Bras. 2007;15:19–24.
45.
TegnerYLysholmJ. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985; 198:43–49.
46.
WeberJCLambDR. Statistics and Research in Physical Education. 1970. St. Louis: C.V. Mosby Company, 69-64, 222.
47.
WilliamsTBurleyDEvansL, et al. The structural validity of the IKDC and its relationship with quality of life following ACL reconstruction. Scand J Med Sci Sports. 2020;30:1748-1757.
