@article {Filbay1465, author = {Stephanie Rose Filbay and S{\o}ren T Skou and Garrett S Bullock and Christina Y Le and Anu M R{\"a}is{\"a}nen and Clodagh Toomey and Allison M Ezzat and Alix Hayden and Adam G Culvenor and Jackie L Whittaker and Ewa M Roos and Kay M Crossley and Carsten Bogh Juhl and Carolyn Emery}, title = {Long-term quality of life, work limitation, physical activity, economic cost and disease burden following ACL and meniscal injury: a systematic review and meta-analysis for the OPTIKNEE consensus}, volume = {56}, number = {24}, pages = {1465--1474}, year = {2022}, doi = {10.1136/bjsports-2022-105626}, publisher = {British Association of Sport and Excercise Medicine}, abstract = {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.Design 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.Data sources MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched inception: 22 November 2021.Eligibility 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{\textendash}14 years post-ACL injury. Pooled PCS scores were worse \>10 years (50.8 (48.7 to 52.9)) compared with 2{\textendash}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 {\textendash}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).Conclusion 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.}, issn = {0306-3674}, URL = {https://bjsm.bmj.com/content/56/24/1465}, eprint = {https://bjsm.bmj.com/content/56/24/1465.full.pdf}, journal = {British Journal of Sports Medicine} }