Summary

Patient-specific psychological characteristics and personality structure significantly affect functional outcomes after arthroscopically assisted ACJ stabilization for acute and chronic ACJ injuries at mid-term follow-up.

Abstract

Background

Clinical evidence pertaining to the influence of patient-specific psychological characteristics and personality structure on outcomes after surgical stabilization of acromioclavicular joint (ACJ) injuries is scarce. Thus, the purpose of the study was to evaluate the impact of psychological factors on functional outcomes and readiness to return to sports of patients undergoing isolated ACJ stabilization for acute and chronic ACJ injuries. It was hypothesized that psychological factors would significantly affect functional outcomes and readiness to return to sports after ACJ stabilization for acute and chronic ACJ injuries at mid-term follow-up.

Methods

Consecutive patients who underwent arthroscopically assisted ACJ stabilization using coracoclavicular suspensory fixation with or without an additional acromioclavicular cerclage for acute or chronic ACJ injuries between 01/2015 to 12/2021 and had a minimum follow-up of two years were analyzed. Chronic injuries (>/=3 weeks after injury) received an additional biological augmentation using a hamstring autograft. Functional outcome measures included the Constant-Murley (CM), American Shoulder and Elbow Surgeons (ASES), and Nottingham Clavicle (NC) score as well as the Visual Analogue Scale (VAS) for pain. Patient-specific psychological characteristics and personality structure were evaluated using the Tampa Scale of Kinesophobia (TSK), General Self-Efficacy Short Scale-3 (GSE-3), Big Five Inventory Scale (BFI), Revised Life Orientation Test (LOT-R), and Pain Catastrophizing Scale (PCS). Psychological readiness to return to sport was assessed with the ACJ-Return to Sport after Injury (ACJ-RSI) scale. The t-test or Mann-Whitney test were used to compare independent groups, while correlations were assessed using the Pearson or Spearman correlation coefficient, as statistically appropriate.

Results

A total of 142 patients (mean age at surgery: 39.2±13.7 years; 93 acute and 49 chronic injuries) with a mean follow-up of 6.0±2.2 years (range: 2.0–11.0 years) were included in the study. Regarding functional outcomes patients had a mean CM of 85.2±13.1, ASES of 93.0±13.1, NC of 86.0±13.8, and VAS for pain of 2.0±1.4 at final follow-up. Pertaining to the patient-specific psychological characteristics and personality structure, a TSK of 17.7±5.6, GSE-3 of 13.8±1.5, and PCS of 5.2±8.3 as well as a LOT-R for optimism of 11.6±2.2 and LOT-R for pessimism of 6.9±2.3 were observed. Further, patients had an ACJ-RSI of 75.0±23.7. The CM, ASES, and NC scores were significantly correlated with the TSK (r=-0.30; r=-0.46; r=-0.35; P<0.001, respectively), the GSE-3 (r=0.32; r=0.40; r=0.42; P<0.001, respectively), and the PCS (r=-0.32; r=-0.42; r=-0.30; P<0.001, respectively). LOT-R for optimism was significantly correlated with ASES (r=0.29; P=0.001) and NC (r=0.27; P=0.003), while LOT-R for pessimism was only significantly correlated with ASES (r=-0.20; P=0.043). With regards to readiness to return to sports, the ACJ-RSI was significantly correlated (P<0.001, respectively) with the CM (r=0.42), ASES (r=0.58), and NC (r=0.64) as well as with the TSK (r=-0.46), GSE-3 (r=0.32), PCS (r=-0.40), and LOT-R for optimism (r=0.35). Six patients in the acute group and 3 patients in the chronic group failed and underwent revision surgery (acute: 6.5%; chronic: 6.1%; P=0.94).

Conclusion

Patient-specific psychological characteristics and personality structure significantly affect functional outcomes after arthroscopically assisted ACJ stabilization for acute and chronic ACJ injuries at mid-term follow-up.