"V体育ios版" Improved sexual activity and quality of life after anterior cruciate ligament reconstruction
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Key findings
• Anterior cruciate ligament (ACL) injury adversely affects sexual function scores alongside quality of life, while reconstructive surgery enhances these scores irrespective of age or sex.
What’s known and what’s new?
• Sexual activity profoundly influences one’s overall quality of life. Sexual dysfunction can significantly adversely affect an individual’s life VSports在线直播. The literature reveals a deficiency in studies regarding the correlation between ACL injuries and sexual activity, and sexual activity is generally not evaluated during patient assessments.
• Reconstructive surgery enhances these scores irrespective of age or sex.
What is the implication, and what should change now?
• When deciding between surgical or conservative treatment, the patient’s expectations for their sexual life after the operation should be considered.
Introduction
Sexual activity profoundly influences one’s overall quality of life. Sexual dysfunction can significantly adversely affect an individual’s life (1). It is intricately connected to both bodily and psychological discontent, as well as hopelessness V体育官网. The World Health Organisation (WHO) defines sexual health as a state of comprehensive well-being that includes physical, emotional, mental, and social dimensions associated with sexuality. Injury and rehabilitation of the anterior cruciate ligament (ACL) might affect persons’ physical health, subsequently impairing their sexual health (2,3). In the United States, around 200,000 anterior cruciate ligament reconstruction (ACLR) surgeries are carried out each year (4-6). The literature reveals a deficiency in studies regarding the correlation between ACL injuries and sexual activity, and sexual activity is generally not evaluated during patient assessments. This study aimed to examine alterations in sexual activity and quality of life subsequent to ACLR. We present this article in accordance with the STROBE reporting checklist (available at https://aoj. amegroups. com/article/view/10. 21037/aoj-25-17/rc).
Methods
Study protocol
The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by Istituto di Cura e Ricovero a Carattere Scientifico (IRCCS) Ospedale San Raffaele (No. CET 125-203) and informed consent was obtained from all individual participants VSports手机版.
The eligibility criteria
The inclusion criteria encompassed patients aged 18 to 65 years who underwent anatomical single-bundle arthroscopic ACLR utilising either a hamstring graft or patellar tendon, adhered to an identical postoperative rehabilitation protocol, were monitored for at least 24 months, and had a duration from injury to surgery not exceeding 6 months.
The exclusion criteria included prior knee surgery (excluding arthroscopic meniscectomy or meniscal repair); infection at the surgery site; bilateral ACL injuries; concomitant injuries, such as posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral (fibular) collateral ligament (LCL), or posterolateral corner (PLC) injuries; absence of sexual activity; internistic, urological, or psychiatric conditions that could affect sexual functionality.
Rehabilitation protocol
All patients received the same standardized postoperative rehabilitation protocol and pain-control program VSports最新版本. It was administered 4,000 U of enoxaparin starting 8 h after surgery. Intraoperatively and after surgery, patients received paracetamol (1 g) every 8 h and ketorolac after 12 and 24 h.
Patients were discharged the day after surgery and followed the following rehabilitation protocol:
v In case of meniscectomy or non meniscal suture, immediate weight-bearing and full range of motion, as well as crutches for balance and comfort, until the patients could walk confidently without limping;
v In case of meniscal suture, non-weight-bearing for 4 weeks and range of motion limited to 0–90° for 4 weeks.
Demographic data (V体育ios版)
The study had 303 patients, including 233 males (76. 9%) and 70 females (23. 1%). The average age at surgery was 31. 6±11. 0 years, and the average follow-up duration was 63. 3±20. 1 months VSports在线直播. A hamstring tendon autograft was used for 289 (95. 4%) patients and a patellar tendon autograft was used for 14 (4. 6%) of patients. The demographic information of the patients is presented in Table 1.
Table 1
| Demographic data | Value (N=303) |
|---|---|
| Gender | |
| Female | 70 (23.1) |
| Male | 233 (76.9) |
| Age | |
| <30 years | 155 (51.2) |
| ≥30 years | 148 (48.8) |
| Side | |
| Right | 147 (48.5) |
| Left | 156 (51.5) |
| Graft | |
| Hamstring | 289 (95.4) |
| Patellar tendon | 14 (4.6) |
| Age (years) | 31.6±11.0 |
| Follow-up length (months) | 63.3±20.1 |
Data are presented as mean ± standard deviation or n (%).
Clinical assessment
Two qualified physicians who were not involved in the patients’ clinical treatment conducted the clinical examination. Every patient who was admitted to the hospital was asked to fill out the New Sexual Satisfaction Scale-Short Form (NSSS-S), answering questions on their sexual behavior both before and after the injury (preinjury and postoperative, respectively) (7) VSports.
The 12-item NSSS-S assesses overall sexual satisfaction independent of sexual orientation, gender, or relationship status. Bancroft, Loftus, and Long’s “three windows” approach—the first of which focuses on individual behaviors, perceptions, and feelings—is the theoretical foundation for this measure. The second window emphasizes emotional communication between partners, and the third window is on sexual activity. The individual focus subscale and the interpersonal/activity focus subscale are the two subscales that make up the NSSS-S (7) VSports app下载.
Furthermore, patients were re-evaluated after a minimum follow-up period of 24 months (final follow-up). The Anterior Cruciate Ligament Quality of Life Questionnaire (ACL-QoL) assessed quality of life at hospital admission (preoperative) and at a minimum follow-up of 24 months (final follow-up) (8).
In order to assess the quality of life of patients with chronic ACL injuries, the Quality of Life Outcome Measure for Anterior Cruciate Ligament Deficiency (ACL-QoL) was created. It consists of 31 items that are separated into 5 domains: physical complaints and symptoms, work-related concerns, recreational activities and participation in sports or competition, lifestyle, and social and emotional aspects. The measuring qualities of both instruments have been evaluated in other languages and have demonstrated high responsiveness and reliability after being translated and modified (8).
Statistical analysis
Descriptive statistics are presented as the mean and standard deviation (SD), median and interquartile range (IQR), or absolute count and percentage frequency. The 30-year cut-off was decided as the median value of the sample included in the study.
The Shapiro-Wilk test was employed to assess the normality of the distribution of continuous variables. The Wilcoxon signed-rank test was conducted to compare scores recorded at various time intervals. The Bonferroni adjustment was applied to the NSSS-S. The link between the NSSS-S score and the ACL-QoL score was assessed using Spearman rank correlation analysis. Subgroup analysis based on sex, and age group was performed utilising the Chi-squared test or Fisher’s exact test for categorical data, and the Mann-Whitney U test for continuous variables. In each analysed group, we assessed potential score variations at several time points using Wilcoxon signed-rank tests and Spearman rank correlations between scores. All tests were bilateral. A P value below 0.05 signifies statistical significance. All statistical tests were conducted using R version 4.3.0 (R Foundation for Statistical Computing, Vienna, Austria).
Results
Sexual function and quality of life
At the final follow-up, sexual activity was significantly higher from preoperative levels (P<0.001), although no difference was observed between preinjury sexual activity and at the final follow-up (P>0.99). Preinjury activity exceeded preoperative activity (P<0.001).
The quality of life at the final follow-up was higher than the preoperative value (P<0.001). The comprehensive results are presented in Table 2.
"V体育官网" Table 2
| Outcome | Mean ± SD | Median [IQR] | Pairwise comparisons (P value) | ||
|---|---|---|---|---|---|
| Preoperatory vs. last follow-up | Preinjury vs. preoperatory | Preinjury vs. last follow-up | |||
| NSSS-S | <0.001* | <0.001* | >0.99 | ||
| Preinjury | 51.38±5.67 | 52.00 [48.00, 56.00] | |||
| Preoperatory | 49.71±5.21 | 50.00 [46.00, 53.00] | |||
| Last follow-up | 51.35±5.42 | 52.00 [48.00, 56.00] | |||
| ACL-QoL | <0.001* | – | – | ||
| Preoperatory | 35.38±7.44 | 34.00 [32.00, 38.00] | |||
| Last follow-up | 83.05±5.65 | 83.00 [80.00, 86.00] | |||
Bonferroni adjustment was used for NSSS-S pairwise comparisons. *, statistically significant difference (P<0.05). ACL-QoL, Anterior Cruciate Ligament Quality of Life Questionnaire; IQR, interquartile range; NSSS-S, New Sexual Satisfaction Scale-Short Form; SD, standard deviation.
Sex
No differences were seen between males and females at each follow-up for sexual activity or quality of life (P>0.05). The comprehensive results are presented in Table 3.
VSports最新版本 - Table 3
| Outcome | Female (N=70) | Male (N=233) | P value | |||
|---|---|---|---|---|---|---|
| Mean ± SD | Median [IQR] | Mean ± SD | Median [IQR] | |||
| NSSS-S | ||||||
| Preinjury | 51.28±6.30 | 52.00* [47.25, 55.75] | 51.40±5.47 | 52.00* [48.00, 56.00] | 0.90 | |
| Preoperatory | 49.97±5.23 | 49.00 [46.00, 53.00] | 49.92±5.19 | 50.00 [47.00, 54.00] | 0.2 | |
| Last follow-up | 51.1±6.09 | 52.00* [47.25, 55.75] | 51.42±5.21 | 52.00* [48.00, 56.00] | 0.97 | |
| ACL-QoL | ||||||
| Preoperatory | 34.74±7.55 | 33.00 [31.00, 38.00] | 35.57±7.40 | 35.00 [32.00, 38.00] | 0.30 | |
| Last follow-up | 82.82±5.41 | 82.00* [79.00, 86.00] | 83.11±5.73 | 83.00* [80.00, 86.00] | 0.70 | |
*, statistically significant difference versus preoperative level (P<0.05). ACL-QoL, Anterior Cruciate Ligament Quality of Life Questionnaire; IQR, interquartile range; NSSS-S, New Sexual Satisfaction Scale-Short Form; SD, standard deviation.
Age
No differences were seen between younger and older patients at any follow-up concerning sexual activity or quality of life (P>0.05). The comprehensive results are presented in Table 4.
Table 4
| Outcome | <30 years (N=155) | ≥30 years (N=148) | P value | |||
|---|---|---|---|---|---|---|
| Mean ± SD | Median [IQR] | Mean ± SD | Median [IQR] | |||
| NSSS-S | ||||||
| Preinjury | 51.85±5.56 | 52.00* [48.00, 57.00] | 50.87±5.74 | 51.00* [47.75, 56.00] | 0.20 | |
| Preoperatory | 50.13±5.10 | 50.00 [47.00, 53.50] | 49.25±5.29 | 49.00 [46.00, 53.00] | 0.20 | |
| Last follow-up | 51.8±5.20 | 52.00* [48.00, 56.00] | 50.87±5.61 | 51.00* [47.75, 55.25] | 0.20 | |
| ACL-QoL | ||||||
| Preoperatory | 36.05±7.4 | 35.00 [32.00, 39.50] | 34.67±7.42 | 33.50 [31.00, 38.00] | 0.10 | |
| Last follow-up | 82.55±5.34 | 82.00* [80.00, 86.00] | 83.56±5.93 | 83.00* [80.00, 87.00] | 0.20 | |
*, statistically significant difference versus preoperative level (P<0.05). ACL-QoL, Anterior Cruciate Ligament Quality of Life Questionnaire; IQR, interquartile range; NSSS-S, New Sexual Satisfaction Scale-Short Form; SD, standard deviation.
VSports app下载 - Discussion
Our study’s primary findings indicated a decline in sexual activity and quality of life following ACL injury, which subsequently improved and stabilised throughout mid-term follow-up after ACLR reconstruction, irrespective of age or sex. The findings of the present study indicate that, while determining the appropriateness of surgical vs conservative treatment, it is essential to enquire about the patient’s sexual life and their postoperative expectations.
Sexual activity significantly influences quality of life, as evidenced by Flynn et al., who found that over 50% of sexually active men and more than 40% of sexually active women across all age groups considered sexual health to be of paramount importance to their quality of life (1).
These results were equally clear among those who claimed to be in moderate or poor health or to have a chronic illness. The authors found a correlation between perceived importance of sexual health and self-reported general health. At least seventy percent of sexually active people who said their general health was good saw sexual health as very important (1,2).
Our findings are analogous to those of earlier scientific research; specifically, Mazlum et al. sought to examine the effects of ACL injury and its restoration on male sexual function (3). The findings of the study demonstrate that ACL injury adversely affects sexual function. The change in sexual function following ACL surgery depends on the surgical results. When determining the treatment for an ACL tear, it is essential to enquire about the patient’s sexual life and their postoperative expectations (3).
A comparable investigation was conducted on sexual constraints in the context of total knee arthroplasty (TKA) (9). Before TKA, 45% of patients reported restrictions in sexual quality attributable to their knee condition. Patients experienced a mean of 17.1 months of sexual limitations before surgery, predominantly attributed to pain (87%) and decreased range of motion (44%). Patients resumed sexual function after an average of 2.4 months, with a range of 0 to 18 months. Despite these overall improvements, 25% of participants experienced a decrease in sexual activity during the first year following surgery. After 1 year of recovery, 60% reported increased ease in engaging in sexual activity compared to the previous year, with 84% of these patients reporting reduced pain and 30% reporting enhanced mobility or range of motion (9).
Our study examined the effects of ACL injury and surgery on quality of life, revealing benefits comparable to those noted prior to surgery. Our findings align with those of Larose et al., who indicated that the duration of wait time for ACLR can adversely impact patients’ quality of life, since it diminishes over an extended period when surgery is postponed (10).
In 2010, Ochiai et al. evaluated the quality of life in individuals with an ACL tear (11). The scores for both mental and physical wellness summary measures in the 36-Item Short Form Health Survey (SF-36) survey fell below the national standard values. The mean amount of anterior tibial translation was 7.8 mm, with no correlation identified with the SF-36 score. The average Lysholm score was 53.3±17.1, indicating a correlation with the mental health component of the SF-36, but not with its physical wellness component (12).
In their systematic review, Filbay et al. also reported that patients evaluated with a knee-specific measure (KOOS-QoL) were more inclined to report inferior health-related quality of life values compared to population norms after ACLR. Revision operations, meniscal injuries, and advanced radiographic osteoarthritis correlated with decreased quality of life outcomes following ACLR (13).
In this research, we employed the NSSS-S to evaluate sexual activity within our patient population. At present, the absence of a universally accepted definition of sexual satisfaction, coupled with significant predictor-criterion overlap, precludes the existence of a definitive criterion or instrument for evaluating sexual satisfaction. The NSSS-S is the abbreviated form of the New Sexual Satisfaction Scale. In the development of the NSSS, sexual satisfaction was framed through an individual perspective (emphasising personal fulfilment), an interpersonal perspective (highlighting interactions with partners), and a behavioural perspective (focussing on specific actions that enhance satisfaction). A recent psychometric study confirmed that the NSSS-S demonstrates strong psychometric properties for a bidimensional evaluation of sexual satisfaction (14).
According to our results and current literature, ACL injury is able to worsening sexual function scores and QoL and reconstructive surgery can improve these scores. The success of surgery affects overall sexual satisfaction. When deciding between surgical or conservative treatment, the patient’s expectations for their sexual life after the operation should be considered.
This research has multiple limitations. The patients’ desired level of sexual activity was not enquired about. The primary drawbacks are the retrospective design concerning preinjury activities and the limited number of patients receiving patellar tendon grafts. Additional extensive, prospective investigations are required to validate these conclusions. Furthermore, that these results are based upon patient’s self-reported sexual activity which may have recall bias.
Conclusions
ACL injury adversely affects sexual function scores alongside quality of life, while reconstructive surgery enhances these scores irrespective of age or sex.
Acknowledgments
We acknowledge the support of the Italian Ministry of Health—“Ricerca Corrente”.
Footnote
Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://aoj.amegroups.com/article/view/10.21037/aoj-25-17/rc
Data Sharing Statement: Available at https://aoj.amegroups.com/article/view/10.21037/aoj-25-17/dss
Peer Review File: Available at https://aoj.amegroups.com/article/view/10.21037/aoj-25-17/prf
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://aoj.amegroups.com/article/view/10.21037/aoj-25-17/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by Istituto di Cura e Ricovero a Carattere Scientifico (IRCCS) Ospedale San Raffaele (No. CET 125-203) and informed consent was obtained from all individual participants.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
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Cite this article as: D’Ambrosi R, Valli F, D’Ambrosi F, Ursino N, Meena A. Improved sexual activity and quality of life after anterior cruciate ligament reconstruction. Ann Joint 2025;10:23.
