Anterior cruciate ligament reconstruction: long-term outcome in adults and adolescents. Clinical results, health-related quality of life, radiographic findings and bone mineral assessments

Abstract: The aim of this thesis was to measure health-related quality of life (HRQoL) and assess pre-operative factors predicting good outcome of HRQoL after anterior cruciate ligament (ACL) reconstruction. Furthermore, to specifically assess long-term radiographic findings, clinical results, and bone mineral density in adolescents after ACL reconstruction. In study I, HRQoL was evaluated using the SF-36 questionnaire 2-7 years after an ACL reconstruction in 419 patients and compared to a gender- and age matched Swedish control group (n=2410). The patient group obtained significantly higher scores for General Health, Social Function, Role Emotional and Mental Health. The control group obtained significantly higher scores for Physical Function compared with the ACL group. After ACL reconstruction the patients reported a good health-related quality of life in comparison with a matched sample of the Swedish population. In Study II pre-operative predictive factors for a good post-operative clinical outcome after ACL reconstruction were evaluated. Seventy three ACL-injured patients answered the SF-36 and KOOS questionnaires, 3-6 years after reconstruction. Predictive factors for HRQoL were investigated using a stepwise regression analysis. Pre-operative factors, such as the pivot shift test, the manual Lachman test, range of motion, Tegner activity level pre-injury and pre-operative may predict a good post-operative outcome in terms of HRQoL after ACL reconstruction. In Study III a long-term follow-up of adolescents after ACL reconstruction was performed. Twenty nine adolescents were evaluated 10-20 years after ACL reconstruction in terms of the presence of osteoarthritis, clinical assessments and HRQoL. In the long term, patients who were adolescents at the time of ACL reconstruction revealed significantly more radiographically visible osteoarthritic changes in their operated knee compared to their non-involved contralateral knee. However, the clinical outcomes and HRQoL were comparable with those of healthy controls. In study IV bone mineral density (BMD) was evaluated in the same 29 adolescents, 10-20 years after ACL reconstruction. The BMD was measured in both calcanei using the DXA (Dual-energy X-ray absorptiometry) technique and compared with a control group of adult ACL reconstructed patients as well as a reference data base with DXA measurements from healthy age matched persons. The BMD in patients who were adolescents at the time of ACL reconstruction differed from a control group and a reference data base. In male patients the BMD value was lower compared with both the control group and the reference data base. In female patients, the BMD value was higher compared to the reference data base. A decrease of one standard deviation in BMD increases the relative risk in any kind of future fracture with 1.5 times. Considering the future fracture risk, it might be of clinical relevance to assess the BMD after ACL reconstruction in adolescents.