Long-term quality of life, work limitation, physical activity, economic cost and disease burden following ACL and meniscal injury: a systematic review and meta-analysis for the OPTIKNEE consensus

• Published in: British journal of sports medicine 2022-12, Vol.56 (24), p.1465-1474
• Main Authors: Filbay, Stephanie Rose, Skou, Søren T, Bullock, Garrett S, Le, Christina Y, Räisänen, Anu M, Toomey, Clodagh, Ezzat, Allison M, Hayden, Alix, Culvenor, Adam G, Whittaker, Jackie L, Roos, Ewa M, Crossley, Kay M, Juhl, Carsten Bogh, Emery, Carolyn
• Format: Article
• Language: English
• Subjects: Absenteeism; anterior cruciate ligament; Arthritis; Bias; Costs; Data collection; Exercise; Joint and ligament injuries; Knee; Meta-analysis; Mortality; Osteoarthritis; physical activity; Population; Quality of life; Rehabilitation; Review; Surgery; Systematic review
• ISSN: 0306-3674; 1473-0480
• DOI: 10.1136/bjsports-2022-105626

ObjectiveDetermine the long-term health-related quality-of-life (HRQoL), work limitation, physical activity, health/economic cost and disease burden of traumatic ACL and/or meniscal injury. Findings will inform OPTIKNEE evidence-based consensus recommendations.DesignRandom-effects meta-analysis evaluated HRQoL (SF-36/SF-12/VR-12 Physical Component Scores (PCS) and Mental Component Scores (MCS), EuroQol-5D (EQ-5D)) stratified by time postinjury, and pooled mean differences (95% CI) between ACL-injured and uninjured controls. Other outcomes were synthesised descriptively. Risk-of-bias (RoB) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) were assessed.Data sourcesMEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched inception: 22 November 2021.EligibilityStudies reporting HRQoL, work limitations, physical activity levels, health/economic costs or disease burden, ≥2 years post-ACL and/or meniscal injury.ResultsFifty studies were included (10 high-RoB, 28 susceptible-to-some-bias and 12 low-RoB). Meta-analysis (27 studies, very low certainty of evidence) estimated a pooled mean (95% CI) PCS of 52.4 (51.4 to 53.4) and MCS of 54.0 (53.0 to 55.0) 2–14 years post-ACL injury. Pooled PCS scores were worse >10 years (50.8 (48.7 to 52.9)) compared with 2–5 years (53.9 (53.1 to 54.7)) postinjury. Excluding high-RoB studies, PCS scores were worse in ACL-injured compared with uninjured controls (−1.5 (−2.9 to –0.1)). Six studies (low certainty of evidence) informed a pooled EQ-5D score of 0.83 (0.81 to 0.84). Some individuals experienced prolonged work absenteeism and modified activities ≥2 years post-ACL injury. ACL injury was associated with significant direct and indirect costs, and early ACL reconstruction may be less cost-effective than rehabilitation. Only three studies evaluated meniscal injury outcomes (all evaluated HRQoL).ConclusionThere is a very-low certainty of evidence that PCS scores ≥2 years post-ACL injury are worse than uninjured controls and decline over time, whereas MCS scores remain high. ACL injury can result in prolonged work absenteeism and high health/economic costs. Further studies are needed to determine the long-term burden of traumatic meniscal injury.