ASSOCIATION BETWEEN PSYCHOLOGICAL READINESS, PATIENT REPORTED OUTCOMES, AND RETURN-TO-SPORT FOLLOWING PRIMARY ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: READINESS OUTCOMES AFFECTING RETURN-TO-SPORT (ROAR)
Authors: Traver Jessica L. , Christino Melissa A. , Coene Ryan , Schaeffer Tyler , Williams Kathryn , Sugimoto Dai , Kramer Dennis E. , Yen Yi-Meng , Kocher Mininder S. , Micheli Lyle J. , Milewski Matthew D. 
Published: April 2020

Background:

Successful return-to-sport (RTS) following anterior cruciate ligament (ACL) reconstruction can be affected by several variables, including a patient’s physical and psychological state throughout the rehabilitation process. Several studies have reported patients with increased fear-of-reinjury may be at risk for secondary injury following ACL reconstruction.

Purpose:

The primary objective was to prospectively compare the relationship between ACL-RSI, Pedi-IKDC, Pedi-FABS, and PROMIS-Psychological Stress Experiences (PSE) across various age groups and graft types between patients undergoing primary ACL reconstruction at the 6-month post-operative visit. Secondary outcomes were timing of RTS clearance and performance on functional RTS testing measures.

Methods:

Patients enrolled were 8-30 years old who underwent primary ACL reconstruction from August 2018 until January 2019. They were evaluated at their 6-month follow-up appointment and underwent functional RTS testing. Patients were divided into 3 groups based on their age: Pre-Adolescent (ages 8-14), Adolescent (ages 15-18), and Adult (ages >18) to reflect their psychological/emotional maturity. Demographic information, time to RTS clearance, and functional testing measurements were collected Analysis included one-way ANOVA and Kruskal-Wallis tests.

Results:

A total of 65 patients were included in the study (38 males, 27 females; mean age, 17.2 ± 3.3 years). The 3 age groups consisted of Pre-Adolescent (n=12), Adolescent (n=34), and Adult (n=19). The graft types were HS (n=51), BTB (n=8), ITB (n=6). Mean ACL-RSI scores were significantly different among age groups (Pre-Adolescent 80.1±11.1, Adolescent 64.2±23.5, Adult 52.5±19.9; p=0.003) and graft type (HS 63±21.9, BTB 54.3±26.7, ITB 81.9±10.6; p=0.049). Scores were significantly different among the 3 age groups for IKDC (Pre-Adolescent 86.2±12.2, Adolescent 80.3±13.6, Adult 62.1±6.5; p<0.001) and Pedi-FABS (Pre-Adolescent 25.3±5.5, Adolescent 24.8±7.1, Adult 19.6±10.0; p=0.049). The mean PROMIS-PSE t-scores were significantly different among the age groups (Pre-Adolescent 45.7±8.9, Adolescent 52.8±7.6, Adult 52.6±7.4; p=0.023) and graft type (HS 52.5±7.6, BTB 53.2±7.6, ITB 39.8±4.4; p<0.001). We found that ACL-RSI and IKDC had a Spearman correlation of 0.52 (p<0.001) while ACL-RSI and PROMIS-PSE had a Pearson correlation of -0.32 (p=0.009). There were no differences between functional testing across the 3 age groups (p>0.05).

Conclusion:

This study suggests that psychological profiles and subjective perceptions of knee function following ACL reconstruction may vary in young patients of different ages. Pre-adolescent patients had better scores on all patient reported outcomes compared to adolescent and adult patients. Age-related differences in patient reported outcomes should be taken into account when evaluating young patients.

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