Effect of Age and Sex on Psychological Readiness and Patient-Reported Outcomes 6 Months After Primary ACL Reconstruction

Abstract

Background: Successful return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR) can be affected by a patient’s physical and psychological state throughout the rehabilitation process. Purpose: To prospectively compare differences in patients at 6 months after primary ACLR with the ACL–Return to Sport after Injury (ACL-RSI), International Knee Documentation Committee (IKDC) or pediatric (Pedi)-IKDC, Hospital for Special Surgery Pediatric Functional Activity Brief Scale (Pedi-FABS), and Patient-Reported Outcomes Measurement Information System–Psychological Stress Experiences (PROMIS-PSE) scores. Study Design: Prospective cohort study; Level of evidence, 2. Methods: Patients enrolled were 8 to 35 years old who underwent primary ACLR and had their 6-month follow-up appointments between December 2018 and March 2020. Patients were divided into 3 age groups as follows: (1) preadolescents (10-14 years); (2) adolescents (15-18 years); and (3) adults (>18 years). Outcomes on the ACL-RSI, IKDC/Pedi-IKDC, Pedi-FABS, and PROMIS-PSE were compared according to age group, graft type (hamstring, patellar tendon, quadriceps, or iliotibial band autograft), and sex. Results: A total of 176 patients (69 male, 107 female), with a mean age of 17.1 ± 3.1 years were included in the study. The mean ACL-RSI scores were significantly different among age groups (preadolescents, 75 ± 18.9; adolescents, 61.5 ± 20.4; and adults, 52.5 ± 19.8 [ P < .001]) and graft types ( P = .024). The IKDC and PROMIS-PSE scores were also significantly different among age groups ( P < .001 and P = .044, respectively) and graft types ( P = .034 and P < .001, respectively), with the iliotibial graft and the younger age group performing the best. There was no significant difference in the Pedi-FABS either by age group ( P = .127) or graft type ( P = .198). Female patients had lower ACL-RSI scores and higher (worse) scores on PROMIS-PSE than their male counterparts ( P = .019 and P < .001, respectively), with no sex-based differences on IKDC or Pedi-FABS scores. The ACL-RSI and IKDC were positively correlated (Spearman r = 0.57; P < .001), while the ACL-RSI and PROMIS-PSE were negatively correlated (Pearson r = –0.34; P < .001). Conclusion: This study suggests that psychological profiles and subjective perceptions of knee function 6 months after ACLR may vary in patients of different ages and between the sexes. Preadolescent patients had better scores on a majority of patient-reported outcomes compared with adolescent and adult patients.

Measurement properties of the Swedish version of the anterior cruciate ligament return to sport after injury scale (ACL‐RSI): A Rasch analysis

“…In terms of DIF, younger patients exhibited lower confidence and greater fear of reinjury, impacting their scores on the ACL‐RSI compared to older patients. This aligns with studies showing that emotional responses significantly affect younger athletes' psychological state towards RTS after ACL reconstruction [ 18 , 23 , 26 ].…”

Anterior cruciate ligament injuries in female athletes: risk factors and strategies for prevention

“… 91 , 92 Also, while both males and females are motivated to be physically active, male athletes may be more likely to endorse competition and winning as motivators for sports participation and, therefore, exhibit more risk-taking behaviours. 93 Milewski et al 94 reviewed 176 patients with a mean age of 17 years undergoing ACLR and found that female athletes had significantly higher levels of injury-related stress and lower levels of perceived psychological readiness to return to sport compared with at six months after surgery.…”