title: Baseline predictors of health-related quality of life after anterior cruciate ligament reconstruction: a longitudinal analysis of a multicenter cohort at two and six years.
abstract: BACKGROUND
  Limited information exists regarding predictors of general quality of life following anterior cruciate ligament (ACL) reconstruction with up to six-year follow-up. We hypothesized that certain variables evaluated at the time of ACL reconstruction will predict the general quality of life as measured by the Short Form-36 (SF-36).
  
  
  METHODS
  All unilateral ACL reconstructions from 2002 to 2004 in patients currently enrolled in a prospective multicenter cohort were evaluated. Patients preoperatively completed the SF-36 validated outcome instrument. Surgeons documented intra-articular pathological conditions and treatment, as well as the ACL reconstruction surgical technique. At baseline and at a minimum of two and six years postoperatively, patients completed the SF-36. Longitudinal analysis was performed for the two-year and six-year end points.
  
  
  RESULTS
  Of the initial 1512 subjects, at least one follow-up questionnaire was obtained from 1411 subjects (93%). The cohort was 44% female, and the median patient age at enrollment was twenty-three years. The mean scores were 41.9 points for the Physical Component Summary (PCS) and 51.7 points for the Mental Component Summary (MCS) at baseline, 53.6 points for the PCS and 52.0 points for the MCS at two years, and 54.0 points for the PCS and 52.4 points for the MCS at six years. Significant predictors of a higher PCS score were a higher baseline PCS score, younger age, lower baseline body mass index, having >50% of the lateral meniscus excised, or having no treatment done on a lateral meniscal tear. In contrast, significant predictors of a lower PCS score were a shorter follow-up time since surgery, revision ACL reconstruction, smoking at baseline, fewer years of education, and chondromalacia of the lateral tibial plateau. The mean utility gained at six years after ACL reconstruction was 5.3 quality-adjusted life years (QALYs).
  
  
  CONCLUSIONS
  Large improvements in the PCS (with an effect size of 1.2) were noted at two years and were maintained at six years after ACL reconstruction. Lower education and smoking were significant predictors of lower PCS and MCS scores. ACL reconstruction resulted in a relatively high gain of QALYs.
authors.affiliation: University of Wisconsin Medical Center, Centennial Building, 1685 Highland Avenue, Madison, WI 53705.
authors.forename: Warren R
authors.initials: WR
authors.lastname: Dunn
authors.affiliation: University of Iowa Sports Medicine Center, 2701 Prairie Meadow Drive, Iowa City, IA 52242.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Wolf
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Suite 11000, 2525 West End Avenue, Nashville, TN 37203-1738.
authors.forename: Frank E
authors.initials: FE
authors.lastname: Harrell
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, 4200 Medical Center East, South Tower, Nashville, TN 37232-8774.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Reinke
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, 4200 Medical Center East, South Tower, Nashville, TN 37232-8774.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Huston
authors.affiliation: Cleveland Clinic, Sports Medicine A-41, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail address: spindlk@ccf.org.
authors.forename: Kurt P
authors.initials: KP
authors.lastname: Spindler
mesh_terms: D059549:Anterior Cruciate Ligament Reconstruction; D002357:Cartilage Diseases / Q000453:epidemiology; D004522:Educational Status; D006305:Health Status Indicators; D006801:Humans; D007718:Knee Injuries / Q000453:epidemiology / Q000601:surgery; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D049451:Nomograms; D011184:Postoperative Period; D011379:Prognosis; D011788:Quality of Life; D012907:Smoking / Q000453:epidemiology
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