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. 2024 Sep 27;12(9):23259671241274768.
doi: 10.1177/23259671241274768. eCollection 2024 Sep.

Assessing the Impact of Psychological Readiness on Performance and Symmetry in Functional Testing After ACL Reconstruction in Pediatric and Adolescent Patients

Angela M Mercurio  1 , Elizabeth J Scott  2 , Dai Sugimoto  3 , Melissa A Christino  1   4 , Ryan P Coene  4 , Emma C Gossman  4 , Danielle L Cook  4 , Mininder S Kocher  1   4 , Dennis E Kramer  1   4 , Yi-Meng Yen  1   4 , Lyle J Micheli  1   4 , Matthew D Milewski  1   4
Affiliations

Assessing the Impact of Psychological Readiness on Performance and Symmetry in Functional Testing After ACL Reconstruction in Pediatric and Adolescent Patients

Angela M Mercurio et al. Orthop J Sports Med. .

Abstract

Background: Readiness for return to sports involves both physical and psychological aspects of recovery; however, the relationship between psychological and physical variables after anterior cruciate ligament (ACL) reconstruction (ACLR) is poorly understood.

Hypothesis: ACLR patients with a higher psychological readiness would demonstrate better functional testing results at 6 months.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: Participants were evaluated at 6 months after ACLR with various patient-reported outcome metrics: Hospital for Special Surgery Pediatric Functional Activity Brief Scale, pediatric or adult International Knee Documentation Committee Questionnaire (IKDC), Patient-Reported Outcomes Measurement Information System (PROMIS) - Psychological Stress Experience and ACL - Return to Sport After Injury (ACL-RSI) scale. Functional testing included quadriceps, hamstrings, and gluteal strength testing; Y-balance test; single-leg single hop, crossover hop, and triple hop tests; and timed 6-m hop test. Pearson correlation coefficient and multivariable regression were used to determine associations between the limb symmetry index (LSI) on functional testing and patient-reported outcomes. Those with LSI deficits <20% (better performance) were compared with those with deficits >20% (worse performance).

Results: A total of 229 participants (89 male, 140 female) with a median age of 17 years (range, 10.3-30.6 years) were enrolled. IKDC had a moderate negative correlation with PROMIS - Psychological Stress Experience (r = -0.39; 95% CI = -0.49, -0.27; P < .001) and a moderate positive correlation with ACL-RSI (r = 0.55; 95% CI = 0.46, 0.64; P < .001). A total of 151 patients completed functional testing. ACL-RSI demonstrated a positive correlation with single-hop LSI (r = 0.21; 95% CI = 0.05, 0.35; P = .01) and timed 6-m hop (r = 0.28; 95% CI, 0.42; P = .001). When adjusting for sex, age, and graft type, patients who had <20% deficit on the single-hop test scored 16.6 points higher on ACL-RSI (P = .001), and those with <20% deficit on crossover hop testing scored a mean 13.9 points higher on ACL-RSI (P = .04).

Conclusion: Higher psychological readiness for return to sport was associated with better performance and greater symmetry on hop testing 6 months after ACLR, suggesting a potential link between physical and psychological recovery.

Keywords: adolescent; anterior cruciate ligament; functional testing; pediatric; psychological readiness.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: M.D.M. has received royalties from Elsevier and serves on the board of directors for PRiSM. M.A.C. has received royalties from Springer Inc and serves on the board of directors for PRiSM. Y-M.Y. is a consultant for Smith+Nephew and serves on the editorial board for the American Journal of Sports Medicine. E.J.S. has received education payments from Smith+Nephew and hospitality payments from Stryker and Zimmer Biomet Holdings. M.S.K. has received royalties from OrthoPediatrics and education payments from Kairos Surgical. D.E.K. has received education payments from Kairos Surgical and consulting fees from DePuy Synthes Products. 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.
Consort diagram detailing how the final cohort of patients used in analysis was chosen. ACL, anterior cruciate ligament; PRO, patient-reported outcome.
Figure 2.
Figure 2.
Correlation between hop testing measurements and ACL-RSI scores. There was a weak positive correlation between the single-hop LSI and ACL-RSI scores (r = 0.21; 95% CI = 0.05, 0.35; P = .01) and a weak positive correlation between the 6-m timed hop LSI and ACL-RSI scores (r = 0.28; 95% CI = 0.11, 0.42; P = .001). ACL-RSI, Anterior Cruciate Ligament - Return to Sport after Injury; LSI, limb symmetry index.
Figure 3.
Figure 3.
Correlation between PROs. There was a moderate negative correlation between IKDC scores and PROMIS-PSE scores (r = -0.39; 95% CI = -0.49, -0.27; P < .001) and a moderate positive association between IKDC scores and ACL-RSI scores (r = 0.55; 95% CI = 0.46, 0.64; P < .001). IKDC here refers to a composite of both adult and pediatric forms of the PRO. ACL-RSI, Anterior Cruciate Ligament - Return to Sport after Injury; IKDC, International Knee Documentation Committee; PRO, patient-reported outcome; PROMIS-PSE, Patient-Reported Outcomes Measurement Information System - Psychological Stress Experience.
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