Prevalence of Posttraumatic Stress Disorder Symptoms Among Young Athletes After Anterior Cruciate Ligament Rupture

Abstract

Background: The risk of depression and the fear of reinjury were documented in recent investigations of patients after anterior cruciate ligament (ACL) ruptures. The extent of psychological trauma accompanying these injuries among young athletes, however, has never been assessed.

Hypothesis: Posttraumatic stress disorder (PTSD) symptoms after ACL injury are present among young athletes with high athletic identities.

Study design: Case series; Level of evidence, 4.

Methods: Patients ≤21 years of age who had suffered an acute ACL rupture were consecutively recruited at a tertiary care center. Patients completed the Horowitz Impact of Event Scale - Revised (IES-R) to analyze for PTSD symptomatology, the Athletic Identity Measurement Scale, and an athlete specialization instrument created at the authors' institution.

Results: A total of 24 patients were consecutively recruited. The mean patient age was 14.5 ± 2.7 years, and 50% of patients were male. More than 87.5% of patients experienced avoidance symptoms, 83.3% acknowledged symptoms of intrusion, and 75% had symptoms of hyperarousal. Patients aged 15 to 21 years incurred a higher severity of PTSD symptoms than younger patients (P = .033). Female patients experienced greater emotional trauma than male patients (P = .017). Finally, patients with high athletic identities experienced greater emotional trauma than those with lesser athletic identities, but this finding was not statistically significant (P = .14).

Conclusion: Following ACL rupture, young athletes experience significant emotional trauma, including symptoms of avoidance, intrusion, and hyperarousal. High school and college athletes, female athletes, and patients with high athletic identities may be most susceptible.

Keywords: ACL rupture; pediatric sports medicine; psychological trauma.

Figure 1.

Prevalence of posttraumatic stress disorder symptom subtypes experienced by patients after an anterior cruciate ligament rupture.

Figure 2.

Mean Impact of Event Scale - Revised (IES-R) and Athletic Identity Measurement Scale (AIMS) scores stratified by age. Patients aged 15 to 21 years experienced greater emotional trauma (P = .033).

Figure 3.

Mean Impact of Event Scale - Revised (IES-R) and Athletic Identity Measurement Scale (AIMS) scores stratified by sex. Female patients were more likely to suffer greater emotional trauma (P = .017).