Lower psychological readiness to return to sport after revision ACL surgery

To investigate psychological readiness and psychological stress in young patients after revision anterior cruciate ligament reconstructions (ACLR).

Revision ACLR patients were evaluated 6-months post-operatively with patient reported outcomes (PROs): Anterior Cruciate Ligament Return to Sport After Injury Scale (ACL-RSI), PROMIS-Psychological Stress Experience (PROMIS-PSE), International Knee Documentation Committee (IKDC/Pedi-IKDC) and Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS). Patient reported outcomes (PROs) of revision ACLR patients were compared to a cohort of primary ACLR patients. Propensity score matching between primary and revision cohorts (2:1) was performed for age, sex, and graft type.

Matching resulted in 90 ACLR patients (60 primary and 30 revision). The revision cohort's mean age was 19.0 (SD ± 3.46) and 63% female. A negative correlation was detected between IKDC and PROMIS-PSE (r = -0.32; 95% confidence interval [CI] = -0.49 to -0.12; p = 0.002) and positive correlation was detected between IKDC and ACL-RSI scores (r = 0.50; 95% CI = 0.32-0.64; p < 0.001). There was a weak positive correlation between Pedi-FABS and ACL-RSI scores (r = 0.25; 95% CI = 0.05-0.43; p = 0.02). Revision ACLR patients had lower ACL-RSI/psychological readiness scores (43.4 vs. 58.7, p = 0.001) and lower Pedi-FABS scores (22 vs. 25, p = 0.02), compared to primary ACLR patients. Regression analysis showed revision patients had a 17-point decrease in ACL-RSI scores compared to primary patients (β = -17.1; 95% CI = -27.32 to -6.79; p = 0.001), controlling for age at primary surgery, meniscus repair, and propensity score. Revision patients had a 17% increase in the time to return to sports clearance compared to primary ACLR patients (95% CI = 1.02-1.34; p = 0.03). No differences were noted in Pedi-IKDC/IKDC or PROMIS-PSE scores between the cohorts.

Patients 6-months post revision ACLR had lower psychological readiness, inferior knee outcomes, and delayed return to sport clearance. Greater attention to the psychological aspects of recovery in revision ACLR patients is important to optimise post-operative care and outcomes.

Level II.