A Comparison of Psychological Readiness and Patient-Reported Function Between Sexes After Anterior Cruciate Ligament Reconstruction

Christopher Kuenze; David R Bell; Terry L Grindstaff; Caroline M Lisee; Thomas Birchmeier; Ashley Triplett; Brian Pietrosimone

doi:10.4085/1062-6050-0034.20

A Comparison of Psychological Readiness and Patient-Reported Function Between Sexes After Anterior Cruciate Ligament Reconstruction

J Athl Train. 2021 Feb 1;56(2):164-169. doi: 10.4085/1062-6050-0034.20.

Authors

Christopher Kuenze¹, David R Bell², Terry L Grindstaff³, Caroline M Lisee¹, Thomas Birchmeier¹, Ashley Triplett¹, Brian Pietrosimone⁴

Affiliations

¹ Michigan State University, East Lansing.
² University of Wisconsin, Madison.
³ Creighton University, Omaha, NE.
⁴ University of North Carolina at Chapel Hill.

Abstract

Context: Postoperative functional and return-to-sport outcomes after anterior cruciate ligament reconstruction (ACLR) differ by sex. However, whether sex disparities are observed in patient-reported outcome measures (PROMs) before return to sport after ACLR is unclear.

Objectives: To compare common PROMs between young men and women who had not yet returned to sport after ACLR.

Design: Cross-sectional study.

Setting: University laboratory.

Patients or other participants: Forty-five young men (age = 18.7 ± 2.7 years, time since surgery = 6.8 ± 1.4 months) and 45 women matched for age (±1 year) and time since surgery (±1 month; age = 18.8 ± 2.8 years, time since surgery = 6.9 ± 1.4 months) with ACLR participated.

Main outcome measure(s): Participants completed the Tegner Activity Scale, ACL Return to Sport After Injury scale, Tampa Scale of Kinesiophobia, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). The PROMs were compared between men and women using Mann-Whitney U tests. Odds ratios were calculated to evaluate the odds of a male reporting a PROM value above the previously established normative value as compared with a female.

Results: Sex differences were present for the IKDC score (P = .01) and KOOS Pain score (P = .04) but not for the Tegner Activity Scale (P = .22), ACL Return to Sport After Injury scale score (P = .78), Tampa Scale of Kinesiophobia score (P = .64), or other KOOS subscales (P values = .40 to .52). The odds of reporting values above normative levels differed only for the IKDC score (odds ratio = 2.72, 95% confidence interval = 1.16, 6.38).

Conclusions: After ACLR, young men and women reported similar levels of knee-related function, fear of movement, and readiness for return to sport and were equally likely to meet clinically meaningful normative values before return to sport. Overreliance on patient reports or objective functional outcomes in evaluating patient progress and readiness for return to sport after ACLR may limit clinicians in their ability to comprehensively evaluate and develop individualized interventional approaches that optimize patient outcomes.

Keywords: ACL Return to Sport After Injury scale; fear of movement; fear of reinjury; quality of life; symptoms.