Paper 57: Age and Sex Differences in Psychological Readiness and Stress at 24-Months Following Primary ACL Reconstruction

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Objectives: Recent studies have noted the importance of psychological readiness for returning to sports after anterior cruciate ligament reconstruction (ACLR). However, little is known regarding how psychological readiness and stress changes over time, especially in relation to age and sex. The purpose of this study was to examine the progression of psychological readiness and stress over time in relation to age and sex after ACLR. We hypothesized that psychological readiness and stress seen at 6-months after ACLR would improve at 24-months post-operatively and that there will remain age and sex differences in psychological readiness and stress at 24-months following ACLR. Methods: In this prospective, longitudinal study, patients (ages 10-30 years) were evaluated with ACL Return to Sport after Injury (ACL-RSI) for psychological readiness, PROMIS-Psychological Stress Experience (PROMIS-PSE) for psychological stress, and International Knee Documentation Committee (IKDC) (Pediatric-IKDC for <17 years and Adult-IKDC for >18 years) for overall knee function in post-ACLR patients. These outcome measures were examined at 6-, 9-, 12-, and 24-months after ACLR and compared by age (10-14 years, 15-18 years, and 19+ years) and sex at 24-months using analysis of variance (p<0.05) with pairwise post-hoc tests (Bonferroni) as needed. Results: Two hundred and forty-two patients were included (mean age: 17.4 years, sex: 60% female), and 33% of this cohort had complete 24-month data for analysis. Scores of the all outcome measures significantly improved over time: ACL-RSI: 62.6±20.5 at 6-months, 68.0±20.8 at 9-months, 74.8±18.4 at 12-months 76.4±20.4 at 24-months, p<0.001; PROMIS-PSE: 54.0±8.4 at 6-months, 51.8±9.1 at 9-months, 50.9±9.1 at 12-months, 51.4±9.5 at 24-months, p=0.009; Pediatric-IKDC: 81.1±11.9 at 6-months, 88.8±10.1 at 9-months, 89.3±13.8 at 12-months, 92.5±14.5 at 24-months, p<0.001; Adult-IKDC: 72.6±12.0 at 6-months, 81.2±11.7 at 9-months, 84.2±13.0 at 12-months, 85.6±14.1 at 24-months, p<0.001. At 24-months, age differences were found in PROMIS-PSE (p=0.014). According to post-hoc tests, 10-14 year old patients showed better PROMIS-PSE scores than 15-18 year olds and 19+ year olds (p=0.034, p=0.017, Figure 1). There were no age differences in ACL-RSI (p=0.077, Figure 1), Pediatric-IKDC (p=0.294), or Adult-IKDC (p=0.263) at 24-months. Sex differences were also detected in PROMIS-PSE at 24-months. Males demonstrated better PROMIS-PSE scores than females at 24-months (p<0.001, Figure 2). There were no sex differences in ACL-RSI (p=0.267, Figure 2), Pediatric-IKDC (p=0.174), or Adult-IKDC (p=0.149) at 24-months. Conclusions: Overall, psychological readiness and stress improved 24-months after ACL reconstruction. At 24-months post-ACL reconstruction, older and female patients continued to report greater stress compared to younger and male patients. Further long-term follow-up research is needed to understand these age and sex related outcome differences. Based on the results of this study, additional clinical care or services may be targeted for the specific populations at increased risk of psychological stress following ACL reconstruction.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.