Lack of Gender-Disaggregated Data for the Psychological Impact of ACL Injury on Adolescents

Background: This literature review examines the prevalence and severity of depression and anxiety symptoms in adolescents following ACL injury, with a focus on gender-disaggregated data. Methods: An electronic search was conducted across databases, including Ovid MEDLINE (R), PUBMED, and the Cochrane Library, covering articles from 1964 to 13 February 2024. Primary search terms were "ACL," "depression," "anxiety," and "adolescent," expanded using medical subject headings (MeSH). Manual searches of the references supplemented the database search. Inclusion criteria included studies on depression or anxiety post-ACL injury in adolescents. The exclusion criteria were studies without adolescent participants or those focusing exclusively on one sex. Results: The search identified 62 studies, of which 5 were ultimately selected for comprehensive analysis. Four studies reported on depression using various scales, and three measured anxiety symptoms. No studies provided gender-disaggregated data. One study found no significant difference in depression scores between adolescent and adult patients. Another study noted that socioeconomic disadvantage correlated with increased depressive and anxiety symptoms post-surgery. An additional study highlighted a significant increase in depression scores from pre- to post-injury among ACL-injured participants compared to uninjured controls. Conclusions: Our understanding of the psychological consequences of ACL rupture on female adolescent patients is incomplete. Given the high incidence of ACL injuries in this patient group and their potential psychological vulnerability, improving the evidence base in this area could address a previously neglected aspect of care, with positive impacts on returning to sport and quality of life. Future studies of high methodological quality are needed to address this gap in the literature.