Summary

Virtual reality augmented anterior cruciate ligament reconstruction results in significantly fewer intraoperative adverse events, significantly less intra-and postoperative patient anxiety, and higher overall patient satisfaction

Abstract

Background

patient anxiety in anterior cruciate ligament reconstruction (ACLR) is a preventable potential risk factor for poor patient satisfaction and surgical outcomes. This study aimed to assess the impact of virtual reality (VR) on the anxiety of patients undergoing ACLR under spinal anesthesia (SA). The primary outcome was the perioperative patient anxiety level as assessed by the State-Trait Anxiety Inventory (STAI) Score. It was hypothesized that virtual reality will not reduce the level of anxiety of patients undergoing ACLR under SA.

Methods

A prospective cohort study of a single-center series of patients undergoing ACLR + Lemaire lateral extra-articular tenodesis (LET) under SA was undertaken. Patients were categorized into 2 groups: group 1 was a control group, where standard ACLR was performed, and group 2 had ACLR performed with VR headset used. Pre- and postoperative VAS pain, comfort, and anxiety were recorded. Additionally, pre-and postoperative patient anxiety was recorded by STAI score. Intraoperative adverse events were recorded including sedation requirements and rescue analgesia), and patient satisfaction was recorded.

Results

A total of 60 patients underwent ACLR + LET under SA. Patients were randomized into 2 groups: Group 1 (n= 30), the control group, had standard ACLR performed. Group 2 (n =30) had ACLR with the use of the VR headset. The mean age in group 1 was 30.6 ± 12.9 years, and in group 2 was 28.8 ± 9.5 years, and the mean BMI was 19.3 ± 1.4 Kg/m2 in group 1 and 19.1 ± 0.8 Kg/m2 in group 2 (All P > 0.05). Intraoperatively, less rescue analgesia and less required sedation were encountered in the VR group the control group (13.3% vs 36.7% (p = 0.03)), and (10% vs 56.7% ( p < 0.0001), respectively. There was no significant difference in preoperative anxiety between both groups either on the VAS or STAI- Y1 scores (Both p = 0.8). The preoperative STAI-Y1 score was 33.3 ± 7.9 in the control group versus 34.9 ± 9.7 in the VR group (p = 0.8). Intraoperatively, there was significantly less anxiety STAI- Y1 score in the VR group of 29.6 ± 7.3 compared to the control group at a score of 36.9 ± 5.8 (p < 0.0001). This continued to be the case postoperatively, with significantly lower anxiety score STAI-Y1 in the VR group versus the control group, 30.6 ± 6.9 versus 37.3 ± 5.7, respectively (p < 0.0001). High VAS satisfaction assessed by both the anaesthesiologist and anesthetic nurse was reported in the VR group versus the control group, (80% vs 36.7%) and (93.3% vs 46.7%) ( all p < 0.0001). VAS pain score was significantly less in the VR group compared to the control group; 2.3± 2.1 versus 3.1 ± 2.9 (p=0.03) in the recovery room, and 2.9 ± 2.7 versus 3.4 ± 3 (p = 0.04) before discharge to home.

Conclusion

Virtual reality augmented anterior cruciate ligament reconstruction results in significantly fewer intraoperative adverse events, significantly less intra-and postoperative patient anxiety, and higher overall patient satisfaction.