The Impact of Psychological and Social Factors on Recovery After ACL Reconstruction

The purpose of this study was to investigate the impact of demographic, psychological, and social factors on self-reported recovery after anterior cruciate ligament (ACL) reconstruction (ACLR).

Psychological and social factors would be associated with lower patient-reported outcome scores (PROMS) after ACLR.

Case series.

Level 4.

Retrospective review was conducted of patients who underwent ACLR at a single institution. Recovery was measured by using the PROMIS 10 SF Global Health Physical score, Lysholm Knee score, International Knee Documentation Committee (IKDC) score, and Knee Outcome Survey (KOS) scores. Multivariable linear regression models were developed to predict 6-month PROMIS 10 SF Global Health Physical, Lysholm Knee, IKDC, and KOS scores. Sociodemographic, surgical, and preoperative PROMS with variance inflation factors >5 were removed to minimize collinearity.

A total of 67 patients who underwent ACLR between December 2013 to August 2023 were included in this study, with a mean age of 31.1 ± 10.3 years. Smoking history was consistently associated with lower 6-month IKDC (β = -33.5 [-54.0, -13.0], P = 0.002), KOS (β = -35.6 [-42.3, -18.4], P < 0.001), and Lysholm (β = -27.6 [-45.1, -10.0], P = 0.004) scores. White race was associated with lower Lysholm scores (β = -8.0 [-13.1, -3.0], P = 0.003). Higher preoperative PROMIS mental health scores were associated with higher KOS (β = 0.4 [0.1, 0.6], P = 0.01). Patients with Medicaid reported higher KOS scores (β = 7.2 [2.4, 12.0], P = 0.004).

Several psychosocial and demographic factors may influence recovery after ACL reconstruction. In our study, smoking predicted worse outcomes, while having Medicaid insurance was unexpectedly linked to better self-reported recovery. White race predicted worse outcomes. Mental health findings were contradictory, with high preoperative PROMIS mental health scores, representing current mental health, and a history of depression potentially associated with improved outcomes.

Identifying psychological and social factors preoperatively can help clinicians better understand which patients may be at risk for lower self-reported outcomes.