Modifiable factors and their association with self-reported knee function and activity after anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

OBJECTIVE: To determine if body mass index (BMI), smoking status, prehabilitation or time to reconstruction are associated with recovery of self-reported knee function and activity after ACL reconstruction (ACLR). DATA SOURCES: Four electronic databases were systematically searched. STUDY SELECTION: English language articles were included if: (1) participants aged 16-70 years had primary or first revision ACLR with autograft, following complete rupture; and (2) the association between one of four modifiable factors: (1) BMI; (2) smoking; (3) prehabilitation; or (4) time to reconstruction with self-reported knee function and activity, ACL graft rupture or return to sport was evaluated. RESULTS: Twelve articles (representing 11 studies) were included. Meta-analyses found low-quality evidence of no difference in self-reported knee function (d = -0.07, 95% CI -0.37 to 0.23, I2 = 0%) or activity levels (d = 0.11, 95% CI -0.2 to 0.41, I2 = 0%) between acute and subacute ACLR. There was no difference in the relative risk of ACL graft rupture with the timing of ACLR (one study). Meta-analysis demonstrated very low-quality evidence that smokers had worse self-reported functional outcomes after ACLR compared to non-smokers (d = -0.58, 95% CI -0.788 to -0.28, I2 = 59%). One study suggested an inverse relationship between BMI and knee-related quality of life after ACLR. One RCT suggested prehabilitation may reduce time to return to sport. CONCLUSION: Low-quality evidence suggests there is no difference in delaying ACLR and very low-quality evidence suggests smokers have worse self-reported functional outcome after ACLR compared to non-smokers. High-quality RCTs are needed to confirm the relationship between the four modifiable factors studied and ACLR outcome.

"It's disappointing and it's pretty frustrating, because it feels like it's something that will never go away." A qualitative study exploring individuals' beliefs and experiences of Achilles tendinopathy.

BACKGROUND: Achilles tendinopathy (AT) is a common and often persistent musculoskeletal disorder affecting both athletic and non-athletic populations. Despite the relatively high incidence there is little insight into the impact and perceptions of tendinopathy from the individual's perspective. Increased awareness of the impact and perceptions around individuals' experiences with Achilles tendinopathy may provide crucial insights for the management of what is often a complex, persistent, and disabling MSK disorder. PURPOSE: To qualitatively explore the lived experiences of individuals with AT. DESIGN: A qualitative, interpretive description design was performed using semi-structured telephone interviews. METHODS: Semi-structured interviews were conducted on 15 participants (8 male and 7 female) with AT. Thematic analysis was performed using the guidelines laid out by Braun and Clarke. The study has been reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist. RESULTS: Four main themes were identified from the data: 1) beliefs and perceptions surrounding AT: "If I'm over training or something, I don't really know", 2) the biopsychosocial impact of AT: "I think it restricts me in a lot of things that I would be able to do", 3) individuals' experiences with the management process: "You want it to happen now. You're doing all this stuff and it's just very slow progress", and 4) future prognosis and outlook in individuals with AT: "I see myself better". CONCLUSIONS: This study offers a unique insight into the profound impact and consequences of Achilles tendinopathy in a mixed sample of both athletic and non-athletic individuals. The findings of this study have important clinical implications. Specifically, it highlights the need for clinicians to recognize and adopt treatment approaches to embrace a more biopsychosocial approach for the management of tendinopathy.