Biopsychosocial risk factors associated with suboptimal outcomes following aclr in the pediatric athlete

Background: Anterior cruciate ligament reconstruction (ACLR) is associated with acute postoperative pain, decreased function, and psychological distress. Studies examining risk factors in pediatric populations following ACLR are limited; however, pediatric studies have found low socioeconomic status and fear of re-injury associated with poor outcomes. Hypothesis/Purpose: This study aims to expand the understanding of biopsychosocial risk factors for postoperative outcomes in pediatric ACLR populations. Methods: A retrospective review of patients that underwent ACLR at a pediatric sports medicine clinic from 5/12/17-5/15/19 was performed. Patients were included in the retrospective chart review if they were between the ages of 12 to 18 years, completed the ACSI-28, PROMIS Global Health 7+2 (PGH-7+2), Pedi-IKDC, and HSS Pedi-FABS, and underwent arthroscopic ACLR for a primary ACL lesion. Medical records were reviewed for demographic, sport involvement, injury, and treatment data collected at initial, pre-operative, first post-operative, one-year post-operative, and final post-operative visits. Results: 107 patients (55F) with an average age of 15.69 years (range 12-18), meeting inclusion criteria were included in this review. Patients were cleared to return to sport (RTS) on average 350.23 days post-surgery. Both days between injury and surgery (109.65 days) and days between initial presentation and surgery (92.64 days) were found to be moderately correlated with RTS (r=0.478; p<0.001 and r=0.525; p<0.001, respectively). Between group comparisons were conducted comparing younger (<14yos) and older (≥14yos) patients. When looking at the PGH-7+2; the <14yos cohort reported significantly higher self-evaluation of health than the ≥14yos cohort (54.93 v 50.08; p=0.004). This younger cohort passed their functional test whereas older counterparts did not (n=13; 1 v 1.15; p=0.045). Patients who passed the functional test during their treatment course (i.e., through final follow-up) reported better pre-operative overall and physical health than those who ultimately failed (PGH-7+2Q1; 4.18 v 3.38, p=0.012; Q3; 4.03 v 3.15, p=0.002). Younger patients were more likely to pass the functional test (15.49 v 17.07 years, p=0.002). Lastly, a comparison between patients who did and did not reinjure their knee post-operatively was reviewed. Reinjured patients reported having increased levels of performance related worry pre-operatively (ACSI-28, FFW; 5.22 v 7.36, p=0.034). Conclusion: These findings suggest older athletes (≥14yos), those with lower perceived overall and physical health ratings, with performance related worry, and/or longer time between injury or initial presentation and surgery will need more pre-, peri-, and post-operative support and resources for optimal outcomes.