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Published on: September 7, 2022
Sex-based differences on pre-operative anxiety and functional outcomes after ACL reconstruction: a retrospective
Cyril Lemé1, Dany Mouarbes2, Ali Alayane2
1Service de Chirurgie Orthopédique et Traumatologique, Toulouse, France.
Background:
Anterior cruciate ligament (ACL) injuries are among the most frequent knee injuries in athletes and young active individuals. Although women sustain ACL injuries more frequently than men, sex-based differences in postoperative outcomes after ACL reconstruction (ACLR) remain unclear. Psychological factors, particularly preoperative anxiety, may also influence postoperative recovery. This study aimed to evaluate sex-based differences in functional and psychological outcomes after ACLR and to investigate the potential influence of preoperative anxiety on postoperative recovery.
Hypothesis:
We hypothesized that female patients would demonstrate differences in functional and psychological outcomes after ACL reconstruction and that preoperative anxiety could influence postoperative recovery.
Patients And Methods:
We conducted a retrospective cohort study at a single academic center including 398 patients (246 men and 152 women) who underwent primary ACL reconstruction between January and December 2022. Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) score, psychological readiness with the ACL Return to Sport after Injury (ACL-RSI) scale, and pain with the Visual Analog Scale (VAS). Preoperative anxiety was measured using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Outcomes were evaluated at 42 days, 6 months, and 12 months postoperatively. Multivariate analyses were performed to adjust for potential confounding factors.
Results:
In unadjusted analyses, men demonstrated significantly higher IKDC and ACL-RSI scores at postoperative day 42 and day 180, as well as higher ACL-RSI scores at one year. However, after adjustment for confounding variables, sex was not significantly associated with functional or psychological outcomes. Women reported significantly higher postoperative pain levels up to 6 months after surgery and higher preoperative anxiety scores (mean 8.91 vs. 8.01; p = 0.038). Preoperative anxiety was negatively associated with ACL-RSI scores at 6 months (β = -2.25; p = 0.001) and 12 months (β = -0.68; p = 0.030), but not with IKDC scores.
Conclusion:
After adjustment for potential confounders, sex was not found to be an independent predictor of functional or psychological outcomes after ACL reconstruction in this cohort. However, higher levels of preoperative anxiety were associated with lower postoperative psychological readiness. These findings suggest that psychological factors, particularly preoperative anxiety, may play an important role in recovery after ACLR and could represent a potential target for perioperative patient management.
Level Of Evidence:
III; retrospective study.
