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Patient satisfaction with health is substantially improved following ACL reconstruction



To prospectively monitor health-related quality of life and return to work after arthroscopic anterior cruciate ligament (ACL) reconstruction in patients with isolated ACL tears.


Sixty consecutive patients with isolated ACL tears who underwent arthroscopic ACL reconstruction were prospectively monitored using the “Questions on Life Satisfaction Modules” (FLZM) and “Short-Form 12 (SF-12)” quality-of-life outcome measures. The Lysholm score and Tegner activity index were used as functional outcome measures. Additionally, return to work (months) together with level of physical workload was analysed. Outcome measures were assessed the day before surgery and at 6, 12 weeks and 6, 12, and 24 months post-operatively. Quality-of-life outcomes were correlated with functional outcome scores.


Satisfaction with health (FLZM) significantly improved within the first 2 years (p < 0.05), and the physical component scale (SF12) showed a significantly higher score after 3, 6, 12 and 24 months as compared with preoperative values (p < 0.05). “General life satisfaction (FLZM)” was initially decreased at 6 weeks (p < 0.05) but increased during the further follow-up period, reaching a score not significantly different from preoperative values. Mean Lysholm score improved from 66 preoperatively to 89 post-operatively (p < 0.05) and the median Tegner activity index improved from four to six points (p < 0.05) at final follow-up. Mean time to return to work was 7 weeks (range 1–34 weeks), and it strongly depended on physical workload. A positive correlation between quality of life and functional outcome (Lysholm score) was observed.


General life satisfaction is impaired during the early post-operative course, but returns to preoperative values after 2 years. Satisfaction with health reaches higher values after 6, 12 and 24 months post-operatively, and the SF-12 physical component scale was seen to improve during the follow-up period. Improved functional outcomes were observed to correlate with quality-of-life measurements. Thus, patients can preoperatively be informed that they will benefit from ACL reconstruction in terms of an improved knee function and satisfaction with health. Heavy physical workload must be considered as a risk factor for prolonged time lost to return to work. These patients have to be identified and informed about realistic expectations.

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  1. Calman KC (1984) Quality of life in cancer patients–an hypothesis. J Med Ethics 10(3):124–127

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Mayr HO, Benecke P, Hoell A, Schmitt-Sody M, Bernstein A, Suedkamp NP, Stoehr A (2016) Single-bundle versus double-bundle anterior cruciate ligament reconstruction: a comparative 2-year follow-up. Arthroscopy 32:34–42

    Article  PubMed  Google Scholar 

  3. Kvist J, Kartus J, Karlsson J, Forssblad M (2014) Results from the Swedish national anterior cruciate ligament register. Arthroscopy 30:803–810

    Article  PubMed  Google Scholar 

  4. Schurz M, Tiefenboeck TM, Winnisch M, Syre S, Plachel F, Steiner G, Hajdu S, Hofbauer M (2016) Clinical and functional outcome of all-inside anterior cruciate ligament reconstruction at a minimum of 2 years’ follow-up. Arthroscopy 32:332–337

    Article  PubMed  Google Scholar 

  5. Filbay SR, Ackerman IN, Russell TG, Macri EM, Crossley KM (2014) Health-related quality of life after anterior cruciate ligament reconstruction: a systematic review. Am J Sports Med 42:1247–1255

    Article  PubMed  Google Scholar 

  6. Henrich G, Herschbach P (2000) Questions on life satisfaction (FLZ M): A short questionnaire for assessing subjective quality of life. Eur J Psychol Assess 16(3):150–159

    Article  Google Scholar 

  7. Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH (2012) Individualized anterior cruciate ligament surgery: a prospective study comparing anatomic single- and double-bundle reconstruction. Am J Sports Med 40:1781–1788

    Article  PubMed  Google Scholar 

  8. Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH (2012) Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281 cases with 3- to 5-year follow-up. Am J Sports Med 40:512–520

    Article  PubMed  Google Scholar 

  9. Karikis I, Desai N, Sernert N, Rostgard-Christensen L, Kartus J (2016) Comparison of anatomic double- and single-bundle techniques for anterior cruciate ligament reconstruction using hamstring tendon autografts: a prospective randomized study with 5-year clinical and radiographic follow-up. Am J Sports Med 44:1225–1236

    Article  PubMed  Google Scholar 

  10. Laucis NC, Hays RD, Bhattacharyya T (2015) Scoring the SF-36 in orthopaedics: a brief guide. J Bone Joint Surg Am 97:1628–1634

    Article  PubMed  PubMed Central  Google Scholar 

  11. Liu Y, Cui G, Yan H, Yang Y, Ao Y (2016) Comparison between single- and double-bundle anterior cruciate ligament reconstruction with 6- to 8-stranded hamstring autograft: a prospective, randomized clinical trial. Am J Sports Med 44:2314–2322

    Article  PubMed  Google Scholar 

  12. Lynch AD, Logerstedt DS, Grindem H, Eitzen I, Hicks GE, Axe MJ, Engebretsen L, Risberg MA, Snyder-Mackler L (2015) Consensus criteria for defining “successful outcome” after ACL injury and reconstruction: a delaware-Oslo ACL cohort investigation. Br J Sports Med 49:335–342

    Article  PubMed  Google Scholar 

  13. Mannion AF, Junge A, Elfering A, Dvorak J, Porchet F (2009) Great expectations: really the novel predictor of outcome after spinal surgery? Spine 34(15):1590–1599

    Article  PubMed  Google Scholar 

  14. Mayr HO, Stüeken P, Münch E-O, Wolter M, Bernstein A, Suedkamp NP, Stoehr A (2013) Brace or no-brace after ACL graft? Four-year results of a prospective clinical trial. Knee Surg Sports Traumatol Arthrosc 22:1156–1162

    Article  PubMed  Google Scholar 

  15. Saier T, Minzlaff P, Feucht MJ, Lämmle L, Burghoff M, Ihle C, Imhoff AB, Hinterwimmer S (2016) Health-related quality of life after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3938-4

    Google Scholar 

  16. Schröter S, Mueller J, van Heerwaarden R, Lobenhoffer P, Stöckle U, Albrecht D (2012) Return to work and clinical outcome after open wedge HTO. Knee Surg Sports Traumatol Arthrosc 21:213–219

    Article  PubMed  Google Scholar 

  17. Shapiro ET, Richmond JC, Rockett SE (1996) The use of a generic, patient-based health assessment (SF-36) for evaluation of patients with anterior cruciate ligament injuries. Am J Sports Med 24(2):196–200

    Article  CAS  PubMed  Google Scholar 

  18. Singh A, Gnanalingham K, Casey A, Crockard A (2006) Quality of life assessment using the Short Form-12 (SF-12) questionnaire in patients with cervical spondylotic myelopathy: comparison with SF-36. Spine 31:639–643

    Article  PubMed  Google Scholar 

  19. Smith SD, Laprade RF, Jansson KS, Arøen A, Wijdicks CA (2013) Functional bracing of ACL injuries: current state and future directions. Knee Surg Sports Traumatol Arthrosc 22:1131–1141

    Article  PubMed  Google Scholar 

  20. Spindler KP, Kuhn JE, Freedman KB, Matthews CE, Dittus RS, Harrell FE (2004) Anterior cruciate ligament reconstruction autograft choice: bone-tendon-bone versus hamstring: does it really matter? A systematic review. Am J Sports Med 32:1986–1995

    Article  PubMed  Google Scholar 

  21. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    Google Scholar 

  22. Thompson SM, Salmon LJ, Waller A, Linklater J, Roe JP, Pinczewski LA (2016) Twenty-year outcome of a longitudinal prospective evaluation of isolated endoscopic anterior cruciate ligament reconstruction with patellar tendon or hamstring autograft. Am J Sports Med 44(12):3083–3094

    Article  PubMed  Google Scholar 

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The authors thank E. Bartsch (Department of Orthopedic Sports Medicine, Technische Universität München, Munich, Germany) for data acquisition.

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Correspondence to Andreas B. Imhoff.

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The authors have no conflict of interest related to this study.


No funding was received.

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The study was approved by the Institutional Review Board of the Technical University of Munich (No. 415/15) and conducted according to the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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Minzlaff, P., Heidt, T., Feucht, M.J. et al. Patient satisfaction with health is substantially improved following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 26, 582–588 (2018).

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  • Anterior cruciate ligament
  • ACL tear
  • ACL reconstruction
  • Arthroscopy
  • Quality of life
  • Return to work