Background: Anterior cruciate ligament (ACL) ruptures are common knee injuries that increase the risk for post-traumatic osteoarthritis. In Aotearoa, about 2,500 people under 30 experience an ACL rupture and undergo ACL reconstruction surgery yearly. Due to the young age at the time of injury, many will experience radiological and symptomatic osteoarthritis before the age of 50 and have a higher likelihood of total knee replacement compared to the general population.

Purpose: This study aimed to gain insight into the long-term impacts of ACLR on people's well-being in Aotearoa by exploring their lived experiences five-plus years post-injury.

Method: We conducted interviews with 12 people aged between 25 and 62 years who had an ACL rupture and had undergone surgical repair. We analysed the interview data using Reflexive Thematic Analysis to identify themes.

Findings: We constructed three themes from the data: 1) Nobody Ever Told Me…, 2) The Post-Rehabilitation Void, and 3) The Elephant in the Room: The Psychosocial Impact. Participants indicated feeling poorly informed of the long-term consequences of ACL rupture and indicated there appeared to be limited long-term rehabilitation and management options after they had recovered from the initial surgery. Participants commonly described fear, grief and long-term psychological and social impacts, and most reported wanting to know more about the long-term management of their knee health.

Conclusion: The study highlights opportunities to provide better long-term support and management, improve outcomes and outcome expectations, and reduce the burden after an ACL rupture.

Impact: ACL injury profoundly impacts people's hauora (well-being). Better education, support services, and consideration of psychosocial factors are needed. Addressing identified barriers could reduce the individual and socioeconomic burden of post-traumatic osteoarthritis following ACL injury for New Zealanders. Future research involving stakeholders must establish acceptable long-term management programs tailored to the local population.

Background: Knee Injury & Osteoarthritis Outcome Score (KOOS) data can be interpreted using the minimal important change (MIC) and patient-acceptable symptom state (PASS). MIC is the minimal change over time patients perceive as important. PASS deals with remission of symptoms and identifies those who consider themselves well. MIC and the PASS complement each other and are used to identify patients who are (1) ‘feeling better’ and (2) those ‘feeling good’, respectively.
Purpose: To determine the proportion of NZ European, Māori, and Pasifika patients who are ‘feeling good’ and ‘feeling better’ from NZ ACL Registry KOOS data.
Methods: KOOS4 at pre-op, 6- and 12-months post-ACLR was calculated from average score of pain, symptoms, sport and quality of life subscales. KOOS4 > 80/100 defined an acceptable symptom state. MIC was 9 points. The proportion of individuals in an acceptable symptoms state and exceeding the MIC was explored 6- and 12-months post ACLR. Chi-square tests were used to explore differences between ethnicities in proportion of patients meeting the criteria.
Results: 4116 patients were included (48% female; 2472 NZ European; 548 Māori; 382 Pasifika). 61% to 62% considered themselves at least minimally improved at 6-months, rising to 72% to 75% at 12 months. At 6-months, 25% NZ European and 25% Māori were in a satisfactory symptom state, versus 22% Pasifika (P < 0.001). At 12-months 42% of Māori (P = 0.08) and 42% of Pasifika (P < 0.001) were in a satisfactory symptom state, versus 46% for NZ European.
Conclusions: A lower proportion of Pasifika report an acceptable symptom state at key timepoints after ACLR. There is a statistical difference between the number who ‘feel better’ versus ‘feel good’ after ACLR in New Zealand but this may not be a clinical difference
Implications: There are potential ethnic disparities in ACLR outcomes in New Zealand