THE EFFECT OF TIME AND SEX ON POST-ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION PSYCHOLOGICAL PATIENT REPORTED OUTCOME MEASURE SCORES.

Abstract

Low scores on psychological patient reported outcomes measures (PROMs), including the anterior cruciate ligament-return to sport after injury (ACL-RSI) and injury-psychological readiness to return to sport (I-PRRS), after anterior cruciate ligament (ACL) reconstruction (ACLR) have been associated with a maladaptive psychological response to injury and poor prognosis. The purpose of this study was to assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores and generate normative reference curves. It was hypothesized that males would demonstrate higher ACL-RSI and I-PRRS scores than females in the first 1-year post-ACLR. Case series. Outpatient sports medicine and orthopedic clinic. 507 patients post-primary ACLR 12-to-30-years-old with 796 ACL-RSI or I-PRRS scores one or more times between 0- and 1-year post-ACLR (age at ACLR: 17.9 ± 3.0 y). An honest broker provided anonymous data from our institution's knee injury clinical database. Generalized additive models for location, scale, and shape and generalized least squares analyses were used to assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores. ACL-RSI and I-PRRS scores increased over time post-ACLR, and males had higher scores compared to females up until approximately five months post-ACLR with scores converging thereafter. Males report higher ACL-RSI and I-PRRS scores compared to females in the initial stages of rehabilitation, but scores converge between sexes at times associated with return to play following ACLR. Normative reference curves can be used to objectively appraise patients' ACL-RSI and I-PRRS scores at any time point post-ACLR. This may lead to timely identification of patients with scores or changes in scores over time post-ACLR associated with a maladaptive psychological response to injury and a poor prognosis and optimized ACLR outcomes.