Original Article
Self-Reported Outcomes After Anterior Cruciate Ligament Reconstruction: An Internal Health Locus of Control Score Comparison

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Purpose: The purpose of this study was to evaluate the influence of high or low internal health locus of control (HLOC) scores on knee function and sports activity self-reports. Methods: The Multidimensional HLOC Scale, the Knee Outcome Survey (KOS) Activities of Daily Living Scale (ADLS) and Sports Activity Scale (SAS), and the 2000 International Knee Documentation Committee (IKDC) Subjective Knee Evaluation and Current Health Assessment surveys were mailed to 335 subjects at a minimum of 2 years after anterior cruciate ligament reconstruction. Results: Of the subjects, 198 returned completed surveys at 5.1 ± 2.9 years after surgery. Compared with the group with low internal HLOC scores, the group with high internal HLOC scores had better KOS-ADLS scores (89.6 ± 13.7 v 77.4 ± 23.9, P < .0001), KOS-SAS scores (85.2 ± 18 v 70 ± 29, P < .0001), global ADLS ratings (90.7 ± 12.8 v 77.4 ± 23.9, P < .0001), global SAS ratings (81.8 ± 20.6 v 70 ± 29.4, P < .0001), 2000 IKDC Subjective Knee Evaluation scores (80.9 ± 17.7 v 68.3 ± 25.2, P < .0001), and 2000 IKDC Current Health Assessment scores for physical function (90.2 ± 14 v 80.5 ± 24.6, P = .001), social function (92.6 ± 14.8 v 85.8 ± 21.1, P = .014), bodily pain (80.7 ± 17.7 v 68.7 ± 24.6, P < .001), mental health (77.9 ± 14.2 v 70.6 ± 19.2, P = .005), and vitality (65.1 ± 19 v 58.8 ± 21, P = .04). Current knee function scores (8.7 ± 1.8 v 7.1 ± 2.9, P < .0001) and KOS-SAS sports activity level scores (χ2 = 11.2, P = .01) were also higher in the group with high internal HLOC scores compared with the group with low scores. Conclusions: Patients with high internal HLOC scores were more satisfied with knee function. Level of Evidence: Level IV, prognostic case series.

Section snippets

Methods

After medical institutional review board approval was obtained, survey packets were mailed to 335 consecutive former patients at a minimum of 2 years after ACL reconstruction. Packets included the Knee Outcome Survey (KOS) Activities of Daily Living Scale (ADLS) and Sports Activity Scale (SAS), the 2000 International Knee Documentation Committee (IKDC) Subjective Knee Evaluation and Current Health Assessment, and the internal HLOC component of the Multidimensional HLOC Survey, Form C.23 Form C

Results

Of the 335 former patients who qualified for study participation, 198 (102 male and 96 female patients) completed the survey packet and returned it via a self-addressed, stamped envelope. Sixteen survey packets were returned unopened because of an incorrect mailing address with no new forwarding address. This produced a 62% return rate (198/319). Patient demographics are listed in Table 1. With regard to the distribution by allograft type, the tibialis anterior, tibialis posterior, or peroneus

Discussion

Studies have shown that older adults with a more internal HLOC are more likely to participate in exercise activities that relate to better perceived health and greater life satisfaction27 and are more likely to participate in a walking program.28 Among college-aged students, having a more internal HLOC is related to increased physical fitness, increased exercise volume, and good body image,29 with individuals in the highest internal HLOC quartile being 77% more likely to exercise compared with

Conclusions

The group with high internal HLOC scores had better self-reported outcomes for knee function as evidenced by 2000 IKDC Subjective Knee Evaluation scores (80.9 ± 17.7 v 68.3 ± 25.2, P < .0001), KOS-ADLS scores (89.6 ± 13.7 v 77.4 ± 23.9, P < .0001), and global ADLS ratings (90.7 ± 12.8 v 77.4 ± 23.9, P < .0001) and better sports activity level scores as evidenced by KOS-SAS scores (85.2 ± 18 v 70 ± 29, P < .0001) and global SAS ratings (81.8 ± 20.6 v 70 ± 29.4, P < .0001) compared with the group

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    Supported by a grant from the Fischer Owen Orthopaedic Fund.

    The authors report no conflict of interest.

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