Summary

The purpose of this study was to expand on how demographic, psychological, and social factors affect the rate of patient healing at increments of 4 weeks, 3 months, and 6 months postoperatively.

Abstract

Objectives: Given the prevalence of anterior cruciate ligament (ACL) injuries, literature has explored variables that impact long-term functional outcomes after ACL reconstruction (ACLR). While previous studies have examined the impact of depression scores, self-efficacy, and kinesiophobia on functional outcomes, there is a paucity of research examining how these factors impact the trajectory of healing rather than only final outcomes. The purpose of this study was to expand on how demographic, psychological, and social factors affect the rate of patient healing at increments of 4 weeks, 3 months, and 6 months postoperatively.

Materials And Methods

A retrospective chart review was conducted from November 2023 to January 2024, examining patients who underwent ACLR surgery at a single institution. This study included 61patients, differentiated by various demographic metrics such as age (mean of 30.6 years), gender (32 female (52%) and 29 male (48%)), and race (37 white (61%), 9 african american (15%), 12 other (20%), and 2 unknown (3%)). Recovery was assessed through patient-reported outcome measures including the PROMIS 10 SF Global Health score, Lysholm Knee score, International Knee Documentation Committee (IKDC) score, and Knee Outcome Survey score. These were measured preoperatively and at approximately 4 weeks, 3 months, and 6 months postoperatively. Furthermore, information on chronic opioid use, anxiety and/or depression diagnoses, psychiatric medications, work status, smoker status, insurance status, Charleston scores, and ADI scores were collected as well. The impact of these variables on recovery was analyzed.

Results

Specific trends and significant correlations between recovery metrics at the various postoperative intervals were identified through analysis via SPSS. Different sets of variables correlated with limitations 6-9 months after injury, quantified via the Lysholm Knee score, IKDC score, and KOS score. Smoking status (Lysholm: ?=5.580, p < 0.100; IKDC: ?=9.509, p < 0.100; KOS: ?=8.259, p < 0.100) and co-surgery (Lysholm: ?=5.811, p < 0.100; IKDC: ?=5.281, p < 0.100; KOS: ?=8.259, p < 0.100) were positively correlated with increased limitations 6-9 months post-surgery measured. Age was negatively correlated with limitations 6-9 months post-surgery (Lysholm: ?=-0.245, p < 0.100; IKDC: ?=-0.262, p < 0.100; KOS: ?=-0.237, p < 0.100). Preoperative PROMIS pain (p < 0.001), PROMIS physical (p < 0.001), Lysholm (p < 0.001), and KOS (p < 0.001) were associated with 6-month limitations via?IKDC?in bivariate analysis. Preoperative PROMIS pain (p < 0.001), PROMIS physical (p < 0.001), Lysholm (p < 0.001), and IKDC (p < 0.001) were associated with 6-month limitations via?KOS?in bivariate analysis. Preoperative PROMIS pain (p < 0.001), PROMIS physical (p < 0.001), KOS (p < 0.001), and IKDC (p < 0.001) were associated with 6-month limitations via?Lysholm?in bivariate analysis. Upon multivariable analysis, smoking was a strong predictor of limitations according to IKDC (partial R2?= -0.545; p = 0.005), KOS (partial R2?= -0.731; p < 0.001), and Lysholm (partial R2?= -0.561; p = 0.004) scores. PROMIS Preoperative Pain scores were a strong predictor of limitations according to IKDC (partial R2?= 0.401; p = 0.047).

Conclusion

The primary findings of this studyhighlight the importance of acknowledging psychological and social factors in the recovery process post-ACLR. Furthermore, the correlation between the Lysholm, IKDC, and KOS scores suggests the importance of administering all three functional tests. The implications of these findings suggest that a holistic approach, including psychiatric care and social support, may be beneficial to recovery outcomes.