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Review
. 2022 Jan 18;10(1):23259671211066493.
doi: 10.1177/23259671211066493. eCollection 2022 Jan.

Self-Reported Symptoms of Depression and Anxiety After ACL Injury: A Systematic Review

Ramana Piussi  1   2 , Tora Berghdal  2 , David Sundemo  2   3 , Alberto Grassi  4 , Stefano Zaffagnini  4 , Mikael Sansone  2 , Kristian Samuelsson  2 , Eric Hamrin Senorski  1   5   2
Affiliations
Review

Self-Reported Symptoms of Depression and Anxiety After ACL Injury: A Systematic Review

Ramana Piussi et al. Orthop J Sports Med. .

Abstract

Background: Depression and anxiety symptoms can occur in patients following an anterior cruciate ligament (ACL) injury, and the presence of these symptoms has been associated with poorer self-reported knee function in this type of injury.

Purpose: To investigate the prevalence and severity of self-reported symptoms of depression and anxiety following an ACL injury.

Study design: Systematic review; Level of evidence, 4.

Methods: PubMed, Cochrane Library, Embase, PsycINFO, AMED, and PEDro databases were searched using a combination of keywords relating to ACL, depression, anxiety, and their synonyms. Inclusion criteria were clinical studies written in English that reported on patients with an injured and/or reconstructed ACL and assessed symptoms of depression and/or anxiety. Data extraction was performed independently by 2 authors. Data synthesis was performed using an emergent synthesis approach. The quality of the included studies was assessed using the methodological index for non-randomized studies or the Mixed-Methods Appraisal Tool. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation.

Results: After abstract screening, 37 studies were assessed in full text, of which 16 were included. The studies comprised 682 patients (417 male [61%]). The depression symptoms appeared to be more severe in elite athletes compared with recreational athletes. Symptoms decreased over time from moment of ACL reconstruction to up to 2 years postoperatively. The prevalence of self-reported symptoms of anxiety after an ACL injury was reported in 1 study (2%). There were no differences in anxiety symptoms between professional and amateur athletes or between adolescents and adults. The overall quality of the studies was low or very low.

Conclusion: Patients who sustain an ACL injury can suffer from symptoms of depression, especially during the first 6 weeks after ACL reconstruction. Depressive symptoms are more common among professional versus nonprofessional athletes. Levels of anxiety symptoms were not above the cutoffs for a diagnosis of anxiety after an ACL injury.

Keywords: anterior cruciate ligament; depressive disorder; knee; psychology; reconstruction.

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Conflict of interest statement

The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Flowchart of the study inclusion process. *Other sources: gray literature and reference lists of included studies.
Figure 2.
Figure 2.
Severity of symptoms of depression. Percentages were calculated by dividing the mean patient-reported outcome (PRO) value provided in the study by the highest possible score for that measurement. ACL, anterior cruciate ligament; ACLR, ACL reconstruction.
Figure 3.
Figure 3.
Severity of anxiety symptoms. Percentages were calculated by dividing the mean patient-reported outcome (PRO) value provided in the study by the highest possible score for that measurement. ACL, anterior cruciate ligament; ACLR, ACL reconstruction; state, state anxiety (anxiety level about an event); trait, trait anxiety (anxiety level as a personal characteristic).
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