目的:确定长期健康相关生活质量(HRQoL),工作限制,身体活动,创伤性ACL和/或半月板损伤的健康/经济成本和疾病负担。研究结果将告知OPTIKNEE基于证据的共识建议。
方法:随机效应荟萃分析评估了HRQoL(SF-36/SF-12/VR-12身体成分评分(PCS)和心理成分评分(MCS),EuroQol-5D(EQ-5D))按伤后时间分层,以及ACL损伤和未损伤对照组之间的合并均值差异(95%CI)。其他结果进行了描述性综合。偏见风险(RoB)和证据的确定性(建议评估分级,开发和评估)进行评估。
方法:MEDLINE,EMBASE,中部,SPORTDiscus,CINAHL搜索开始时间:2021年11月22日。
未经评估:报告HRQoL的研究,工作限制,身体活动水平,健康/经济成本或疾病负担,ACL和/或半月板损伤后≥2年。
结果:纳入了50项研究(10项高RoB,28个容易受到某些偏差的影响,12个低RoB)。荟萃分析(27项研究,证据的确定性非常低)估计,ACL损伤后2-14年的合并平均值(95%CI)PCS为52.4(51.4至53.4),MCS为54.0(53.0至55.0)。与受伤后2-5年(53.9(53.1至54.7))相比,合并的PCS评分在10年(50.8(48.7至52.9))更差。不包括高RoB研究,与未受伤的对照组相比,ACL受伤的PCS评分更差(-1.5(-2.9至-0.1))。六项研究(证据确定性低)得出的合并EQ-5D得分为0.83(0.81至0.84)。有些人在ACL损伤后≥2年经历了长时间的旷工和改良活动。ACL损伤与显著的直接和间接成本相关,早期ACL重建的成本效益可能低于康复。只有三项研究评估了半月板损伤的结果(全部评估了HRQoL)。
结论:有非常低的确定性证据表明,ACL损伤后≥2年的PCS评分比未受伤的对照组更差,并且随着时间的推移而下降,而MCS分数仍然很高。ACL损伤可导致长期旷工和高健康/经济成本。需要进一步的研究来确定创伤性半月板损伤的长期负担。
OBJECTIVE: Determine 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.
METHODS: Random-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.
METHODS: MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched inception: 22 November 2021.
UNASSIGNED: Studies reporting HRQoL, work limitations, physical activity levels, health/economic costs or disease burden, ≥2 years post-ACL and/or meniscal injury.
RESULTS: Fifty 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).
CONCLUSIONS: There 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.