Summary

As the first study to date to examine psychological readiness to return to sport in young patients after revision ACLR, at 6-months post-surgery, revision ACLR patients had lower psychological readiness scores, inferior knee functional outcomes scores, and delayed return to sport clearance.

Abstract

Background

Revision ACL reconstruction (ACLR) has demonstrated worse functional outcomes and higher reinjury rates in young patients. Psychological associations with revision surgery have not previously been evaluated.

Purpose

To investigate levels of psychological readiness and psychological stress in young patients after revision ACLR

Methods

Patients, ages 10-35, were enrolled who underwent revision ACLR at one center by one of six surgeons. Psychological readiness and psychological stress was assessed 6-months post-operatively with the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) and PROMIS-Psychological Stress Experiences (PROMIS-PSE), respectively. The International Knee Documentation Committee (IKDC/Pedi-IKDC), and Hospital for Special Surgery Pediatric Functional Activity Scale (HSS Pedi-FABS) were also collected. Patient reported outcomes of revision ACLR patients were compared to a cohort of primary ACLR patients. Propensity score matching 3:1 was performed for age, sex, and graft type.

Results

Matching resulted in 81 ACLR patients (57 primary and 24 revision). Mean age in the revision group was 18.6 ± 3.2 (66.7% female). The most common graft type in both the primary and revision group was BTB (65% and 67%, respectively). Mild negative correlation was detected between IKDC and PROMIS PSE (r=-0.31; 95% CI=-0.49, -0.10; p=0.005) and a moderate positive correlation was detected between IKDC and ACL-RSI scores (r=0.56; 95% CI=0.39, 0.70; p<0.001). Revision ACLR patients had lower psychological readiness scores (47 vs. 64, p=0.004) and lower IKDC/Pedi-IKDC scores (72 vs 78, p=0.05), compared to primary ACLR patients. Revision ACLR patients also had longer return to sports clearance compared to primary ACLR (median, 10 months vs 8 months; p=0.02). Regression analysis showed revision patients could expect a 15-point decrease in ACL RSI scores compared to patients who underwent primary ACLR surgery (95% CI=-25.30, -4.21; p=0.007). Furthermore, revision patients also could expect a 1.4 month longer return to sports clearance date compared to primary ACLR patients (95% CI=0.29, 2.60; p=0.01). No differences were noted in Pedi-FABS or PROMIS-PSE scores between revision and primary patients.

Conclusion

This study is the first to date to examine psychological readiness to return to sport in young patients after revision ACLR. At 6-months post-surgery, revision ACLR patients had lower psychological readiness scores, inferior knee functional outcomes scores, and delayed return to sport clearance. Greater attention to the psychological aspects of recovery in the revision ACLR setting may be important to help optimize post-operative care and outcomes.