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Primary Versus Revision Autograft Anterior Cruciate Ligament Reconstruction: Psychological Readiness At Return To Sport:

Primary Versus Revision Autograft Anterior Cruciate Ligament Reconstruction: Psychological Readiness At Return To Sport:

Matthew Butler Reid, MD, UNITED STATES Kyle Lauck, BS, UNITED STATES Brian Randall Duncan, PT, DPT, UNITED STATES Emily Gardner, PT, DPT, UNITED STATES Jacquelyn Kleihege, PT, MPT, UNITED STATES Walter Richard Lowe, MD, UNITED STATES Lane Bailey, PT, PhD, DPT, CSCS, UNITED STATES

Memorial Hermann - IRONMAN Sports Medicine Institute, Houston, TX, UNITED STATES


2021 Congress   ePoster Presentation     Not yet rated

 

Anatomic Location

Anatomic Structure

Treatment / Technique

Ligaments

ACL

Patient Populations

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Summary: Revision ACL autograft reconstruction was associated with increased time and lower psychological readiness scores at time of release to return to sport.


PURPOSE/HYPOTHESIS: The common goal for many athletes undergoing ACL reconstruction (ACLR) is to return to their preinjury level of sport participation. However, return to preinjury level of sports rates following primary ACLR are unsatisfactory, and commonly reported at around 65%. Even more discouraging are the return to sport rates for athletes undergoing revision ACLR, which are often much lower at approximately 45%. Knowing that psychological readiness is associated with successful return to sport and self-perceived preinjury sports performance, the purpose of this study was to compare psychological readiness at return to sport between patients undergoing revision ACL autograft reconstruction to matched controls undergoing primary ACL autograft reconstruction.

NUMBER OF SUBJECTS: One hundred eighty-four (mean ± SD age, 29.9 ± 10.0 years; 40% female) patients undergoing primary (n = 92) or revision (n = 92) ACL reconstruction.

Materials And Methods

Data were gathered using a single-surgeon database of 1349 patients who underwent ACL reconstruction from 2015 to 2018. Patients undergoing revision ACLR who met the study criteria were matched by age, sex, graft type, and rehab protocol to a control group of patients receiving primary ACL reconstruction. Functional assessment at release-to-sport was examined using passive ROM, Y Balance reach test, and single-leg hop testing. Self-reported outcomes included the International Knee Documentation Committee (IKDC) subjective function survey and the ACL- Return to Sport After Injury (ACL-RSI) psychological readiness scale. Time to release to play for both patient groups was recorded as the number of months needed to reach 90% symmetry between operative and nonoperative limbs from the date of the index ACLR. Data were assessed for normality using Shapiro-Wilk test and univariate generalized linear models were utilized with an alpha level of .05. RESULTS: There were no differences in any of the baseline patient and surgical demographics including BMI, MARX score, and concomitant meniscal involvement (P>.05). Graft type was matched and yielded similar distribution between primary and revision groups, respectively (patellar tendon, 72.8% versus 69.3%; quadriceps tendon, 18.6% versus 21.1%; hamstring tendon, 8.6% versus 9.6%; P = .644). At return to sport, mean ACL-RSI scores were statistically different between the primary ACLR and revision ACLR groups (85.3 ± 17.4 versus 77.4 ± 19.4, P = .011), however no other functional or self-reported differences were observed. Additionally, the primary group was able to return to sport earlier than the revision group (8.1 ± 1.3 versus 9.4 ± 2.0 months, P<.001).

Conclusions

Revision ACL autograft reconstruction was associated with increased time and lower psychological readiness scores at time of release to return to sport.

CLINICAL RELEVANCE: Serial monitoring of psychological readiness during the rehabilitation process may improve outcomes for return to sport in patient's undergoing revision ACLR and identify those at risk for increased time to return to sport. Apart from time, similar functional performance can be achieved regardless of surgical setting (ie, primary versus revision).


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