Preoperative Low Resilience Associated with Female Patients and High Resilience Associated with Improved Mental Health Scores during ACL Reconstruction

PURPOSE The purpose of this prospective study is to evaluate the relationship between resilience, as measured by the Brief Resilience Scale (BRS), and patient reported outcome measures (PROMs) following primary anterior cruciate ligament reconstruction (ACLR). METHODS A cohort of seventy-two patients undergoing primary ACLR were followed for a minimum of 2 years. Preoperative BRS scores were collected, and patients were categorized into low resilience (LR), normal resilience (NR) and high resilience (HR). PROMS including the Visual Analog Scale measuring overall pain level from 0-10 (VAS), Veterans Rand 12-Item Health Survey Physical Component and Mental Component (VR-12P and VR-12M), Knee Injury and Osteoarthritis Outcomes Score (KOOS) and Marx Activity Rating Scale (MARS) were collected preoperatively as well as up to 2-years postoperatively and compared among the various resilience groups. RESULTS BRS scores were significantly associated with VAS, VR-12M and KOOS outcome scores. There was a significant difference among all three resilience groups (p = 0.0382) in change of VAS score from baseline to 2-years postoperatively, with a mean difference of 2.5 points, 1.1 points and 0.7 points for LR, NR and HR groups respectively. There was a significant association of higher VR-12M scores with higher resilience scores preoperatively (p<0.0001) and at both 1 (p=0.0034) and 2-years (p=0.0235) postoperatively. Higher resilience scores were associated with higher KOOS scores at 1-year postoperatively (p = 0.0270). Female patients were more likely to fall into the LR group (80%). CONCLUSIONS In this cohort of patients undergoing ACLR, low resilience is positively associated with greater improvement in pain and females tend to have more patients in the LR group. At 1-year postoperatively higher resilience scores were positively associated with higher aggregated KOOS scores. At 1 and 2-years postoperatively higher resilience was positively associated with improved VR-12M scores. LEVEL OF EVIDENCE Level II: Prospective Cohort Study