ADHD Is Associated With Increased Rates of Postoperative Complications and Revision Surgery After ACL Reconstruction
Jared Sasaki1, Samuel I Fuller2, Joseph Kocan2
1School of Medicine, New York Medical College, Valhalla, New York.
Background:
Anterior cruciate ligament (ACL) tears represent half of all knee injuries and are often treated surgically through ACL reconstruction. Recent attention has focused on mental health factors as potential modifiable risk factors in ACL reconstruction outcomes. However, no studies have looked at ACL reconstruction outcomes in patients with attention-deficit/hyperactivity disorder (ADHD). This study aimed to assess the effect of ADHD on 3-month, 6-month, and 3-year complications in patients undergoing ACL reconstruction.
Hypothesis:
There will be increased rates of complications in ADHD patients, compared with non-ADHD patients, after ACL reconstruction.
Study Design:
Retrospective case-control study.
Level Of Evidence:
Level 3.
Methods:
We queried TriNetX, a global research database, to analyze patients who underwent an ACL reconstruction surgery and divided them into ADHD and non-ADHD cohorts. We examined outcomes from 1 day to 3 months, 1 day to 6 months, and 6 months to 3 years postoperatively. For the 1-day to 3-month and 6-month outcomes, we examined arthrofibrosis, infection, wound complications, revision surgery, emergency department visits, and readmission. We examined arthrofibrosis, chronic instability, and revision surgery between 6 months and 3 years. Cohorts were propensity score matched.
Results:
In the 1-day to 3-month and 6-month cohorts, ADHD patients were found to have a significantly increased risk of requiring revision surgery, having wound complications, and experiencing hospital readmission compared with the non-ADHD group. ADHD patients were also more likely to return to the emergency department within 6 months. At 3 years follow-up, there were no differences between cohorts.
Conclusion:
This study demonstrates that patients with ADHD who undergo ACL reconstruction are at increased risk of early revision surgery, wound complications, and hospital readmission.
Clinical Relevance:
These findings can be useful to healthcare professionals to help reduce the risk of complications in ADHD patients undergoing ACL reconstruction by tailoring postoperative rehabilitation protocols.
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Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings.