| Summary: | <strong>Background</strong> ACL-reconstructed individuals commonly experience impaired longer-term quality of life (QOL) which may be related to persistent knee symptoms or radiographic osteoarthritis (ROA). Understanding the impact of knee symptoms and ROA on QOL after ACL reconstruction may assist in developing appropriate management strategies. <strong>Objectives</strong> 1. Compare QOL between ACL-reconstructed groups: i) symptomatic with ROA, ii) symptomatic without ROA, iii) asymptomatic (unknown ROA status) 2. Identify specific aspects of QOL impairment in symptomatic ACL-reconstructed individuals with and without ROA <strong>Methods</strong> 113 participants completed QOL measures (KOOS-QOL, ACL-QOL, AQoL-8D) 5-20 years after ACL reconstruction. 81 symptomatic individuals underwent radiographs and 32 asymptomatic individuals formed a comparison group. ROA was defined as Kellgren & Lawrence ≥2 for the tibiofemoral and/or patellofemoral joint. Mann-Whitney U tests compared outcomes between groups. Individual ACL-QOL items were used to explore specific aspects of QOL. <strong>Results</strong> In symptomatic ACL-reconstructed individuals, ROA was related to worse knee-related QOL (KOOS-QOL: median(IQR) 50(38, 69) vs. 69(56, 81), p<0.001; ACL-QOL: 51 (38, 71) vs. 66 (50, 82), p=0.04). Health-related QOL (AQoL-8D) was impaired in both symptomatic groups compared to the asymptomatic group. ACL-QOL item scores revealed greater limitations and concern surrounding sport and exercise, and social/emotional difficulties in the symptomatic group with ROA. <strong>Conclusions</strong> Osteoarthritis is associated with worse knee-related QOL in symptomatic ACL-reconstructed individuals. Diagnosing ROA in symptomatic ACL-reconstructed individuals may be valuable since these individuals may require unique management. Targeted strategies to facilitate participation in satisfying activities has potential to improve QOL in symptomatic ACL-reconstructed people with ROA.
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