The Impact of Knee Injury History on Health-Related Quality of Life in Adolescent Athletes
Lam KC & Markbreiter JG. J Sport Rehab. 2017; Online Ahead of Print September 19, 2017.
Take Home Message: Adolescent athletes with a previous knee injury history report poor quality of life scores that effect their physical functioning as well as their social and school functioning.
Many college athletes and military cadets with a knee-injury history often report poor patient-reported outcomes (e.g., impaired health-related quality of life) after returning to physical activity. It remains unclear if this is true among younger athletes. Hence, the researchers completed a cross-sectional study to see if knee-injury history was associated with lower quality of life among adolescent athletes who were cleared to participate in sports. The researchers asked 183 interscholastic athletes to complete a health history questionnaire, pediatric International Knee Documentation Form (IKDC; overall quality of life), and Pediatric Quality of Life (emotional, physical, social, and school functioning scales) during pre-season assessments. Thirty-six athletes reported a previous knee-injury history, with ligament sprains being the most common. Athletes with a previous knee injury history had lower quality of life, physical function, social function, and school function as well as lower IKDC scores. The researchers observed no differences for emotional functioning or when accounting for gender.
These authors showed that adolescent athletes, who were medically cleared for sports, are reporting poorer quality-of-life related outcomes if they have a knee-injury history. It would have been interesting to see if athletes with a history of major knee injury (surgical) versus chronic injury responded differently. However, these findings seem consistent with what has been found in other populations. Patients across multiple levels of sport are still reporting problems despite being medically cleared to return to physical activity and/or sport. With knee-injury history being a risk factor for long-term problems such as osteoarthritis, we should be paying more attention to this as it seems our patients are trying to tell us something is wrong. A interesting finding in this study was that adolescents with a knee-injury history are reporting problems in the classroom and socially with peers. Pain and quality of life are known to lead to long-term problems, but this is one of the first studies to find very early effects in young athletes. This could be very problematic for their future mental and physical health and development. It would be very interesting to follow these athletes long-term. As clinicians, our patients are trying to tell us that they don’t feel normal and that it effects many areas of their life – not just their physical function. We need to be more attentive to this, and see if there are interventions that might help our patients with a knee-injury history.
Questions for Discussion: Are you currently using any patient reported outcomes after knee injury? Are there any strategies that you have used to try to address poor quality of life after knee injury?