Return to sport matters — longer-term quality of life after ACL reconstruction in people with knee difficulties

Many individuals experience long-term quality of life (QOL) impairment following anterior cruciate ligament reconstruction (ACLR). Factors contributing to poor QOL and psychological health >5\ua0years after ACLR remain unclear. This study aimed to describe QOL and psychological health outcomes in people with knee difficulties (pain, symptoms, or functional limitations) 5-20\ua0years following ACLR and identify factors explaining variability in these outcomes. Participants with knee difficulties 5-20\ua0years following ACLR completed a battery of validated patient-reported outcomes [including the Knee injury and Osteoarthritis Outcome Score (KOOS), ACL-QOL, and the Assessment of QOL (AQoL-8D) instrument]. Multivariable linear regression was used to identify factors explaining variability in outcomes. One hundred sixty-two participants aged 38\ua0±\ua09 (mean\ua0±\ua0SD) years completed questionnaires 9\ua0±\ua04 (range 5-20) years following ACLR. Thirty-nine percent of participants returned to competitive sport, 28% returned to a lower level, and 32% did not return to sport\ua0after ACLR. Not returning to sport after ACLR was associated with worse KOOS-QOL (β\ua0=\ua00.29, P\ua0=\ua00.001 [mean\ua0±\ua0SD (55\ua0±\ua020)], ACL-QOL [β\ua0=\ua00.48, P\ua0< 0.001; (57\ua0±\ua021)], and AQoL-8D [β\ua0=\ua00.22, P\ua0=\ua00.02 (0.80\ua0± 0.14)]) scores. Increased body mass index (56% were overweight/obese) was related to worse QOL and more depressive symptoms. Subsequent knee surgery and contralateral ACLR were also associated with poorer QOL outcomes in these individuals