Impairment in quality of life following sports‐related musculoskeletal injuries: A comprehensive analysis of the German Arthroscopy Register

We read with appreciation the article by Szymski et al. [2], which utilized the German Arthroscopy Registry (DART) data to detail the severe impact of preoperative sports orthopaedic injuries on quality of life (QoL). We aim to both substantiate the authors' core finding—that the decline in QoL is comparable to that of cardiology and oncology patients—with complementary epidemiological evidence and to advance it by proposing methodological recommendations for clinical application. The QoL decline identified by the authors suggests that musculoskeletal pathology constitutes a persistent and severe societal burden, not only in the surgical candidate population but also across broader geographic regions in young adults. Our previous epidemiological study [1], which reviewed the medical fitness reports of over 1.7 million young adult male candidates for compulsory military service in Turkey, demonstrated that the most common causes for complete unfitness were major lesions, such as limitation of joint mobility and joint surface degeneration stemming from fracture sequelae. These chronic conditions carry the potential for a more permanent and prolonged QoL impairment compared to the acute sports injuries examined in the DART. When these two studies are synthesized, they confirm that musculoskeletal pathologies (both acute sport injuries and major trauma sequelae) are not simply biomechanical deficits but a critical public health issue on a global scale, fundamentally affecting the individual's QoL. Integration of more sensitive psychological measures: While the EuroQol 5 Dimensions (EQ-5D) “Anxiety/Depression” dimension is valuable, it may not fully capture sport-specific psychological factors like kinesiophobia (fear of re-injury). We recommend standardizing the inclusion of tools such as the Anterior Cruciate Ligament–Return to Sport after Injury Scale (ACL-RSI) to measure return-to-sport anxiety, or general psychological screening tools like the Hospital Anxiety and Depression Scale (HADS) [3], into the preoperative QoL assessment. This will facilitate the early identification of patients requiring focused psychological intervention. Multidisciplinary biopsychosocial models: The urgent integration of Biopsychosocial Approaches into clinical protocols is needed, where groups with the lowest QoL are supported by a sports psychologist or psychotherapist alongside preoperative physical therapy. This holistic model will not only improve preoperative QoL but also has the potential to enhance compliance with postoperative rehabilitation and increase safe return-to-sport rates. The work by Szymski et al., strongly supported by our epidemiological data, compels the orthopaedic community to shift towards a treatment paradigm that centres patient success (QoL and psychosocial well-being) over mere functional success (biomechanics). To mitigate the identified QoL reduction and maximize healing outcomes, enriching standard surgical protocols with dedicated psychosocial support mechanisms is essential. The authors declare no conflict of interest. The authors have nothing to report.