ABSTRACT
Background: Return-to-sport (RTS) following anterior cruciate ligament reconstruction (ACLR) is influenced by multiple physical and psychological variables. Psychological readiness has been associated with improved patient reported outcomes as well as RTS rates in young athletes. The COVID-19 pandemic may have altered the typical recovery process for patients undergoing ACLR. Hypothesis/Purpose: To compare 6-month postoperative levels of psychological readiness to RTS in ACLR patients before and during the pandemic. Methods: Patients were prospectively enrolled 6 months after primary ACLR at a single academic sports medicine practice, from December 2018 until May 2021. Patients were categorized into pre-COVID (enrollment prior to March 13, 2020) and COVID groups (March 13, 2020 - May 26, 2021). Demographic information, outcomes scores including the ACL-Return to Sport after Injury Scale (RSI) and PROMIS Psychological Stress Experiences (PROMIS-PSE), and physician RTS clearance were obtained and compared for both groups. Comparisons were performed utilizing Chi-square, Student's t-tests and linear regression. A matched analysis was conducted between groups controlling for age, sex, and graft type. Results: 231 patients were included in the present study (89 males, 142 females;mean age 16.9 years), with 76% (176/231) in the pre-COVID group and 24% (55/231) in the COVID group. There were no significant differences in age and sex between the two population cohorts. There was a significant difference in time from surgery to enrollment in the COVID group compared to the pre- COVID group (7.1 vs 6.2 months, p<0.001). In the matched cohort (n=126, 37/126 COVID group), the COVID group was cleared earlier by their physician to RTS compared to the pre-COVID group (6.9 months vs 8.5 months, p<0.001). While there was no significant difference between groups in 6 month ACL-RSI scores (63.8 pre-COVID vs 66.6 COVID, p=0.48), both groups yielded globally low scores. There were no significant associations between matched groups in PROMIS-PSE (p=0.71), IKDC (p=0.55), Pedi-IKDC (p=0.15), and Pedi-FABS (p=0.77) scores (Table 1). Conclusion: Young athletes demonstrated similar levels of psychological readiness to RTS at 6 months following ACLR prior to and during the COVID-19 pandemic. Patient-reported outcome scores were similar in pre-COVID and COVID ACLR patients, suggesting that the pandemic may not have played a detrimental role in perceptions of recovery. Psychological readiness may not be fully optimized at 6 months post-ACLR and young athletes may benefit from additional time and training for progressive confidence, muscle strength, and performance.
ABSTRACT
Objectives: The COVID-19 pandemic has stressed the US healthcare system in unprecedented ways. As a response to the spread of the virus, elective surgeries throughout the country have been canceled, in an effort to minimize further transmission. To our knowledge, the effects of delayed surgeries on patients have not been investigated. Thus, the purpose of this study was to evaluate the physical and psychological consequences of elective surgery delays on young sports medicine patients. Methods: We conducted a cross sectional study of patients, ages 10-25 years old, who had sports medicine surgery delayed between March and May 2020 due to the COVID crisis. All patients were still awaiting surgery at the time of the initial survey. Electronic surveys were sent to patients and included the 12-item Short Form Health Survey (SF-12), which yields a physical component score (SF12-PCS) as well as a mental component score (SF12-MCS), the PROMIS Psychological Stress Experience survey (PROMIS-PSE), and self-designed questions about patient concerns regarding the COVID crisis and delayed surgery. A higher score on SF-12 subscales signifies better health, whereas a higher score on the PSE indicates more psychological stress. Scores that deviate significantly from a mean of 50 indicate a difference from the general population norm. Results: Of the 146 eligible patients with delayed elective sports surgeries, 89 patients (61%) elected to participate (mean age 17.7±2.9 years, 30% male). The median length of surgical delay was 36 days (range 9-54), and 79% of patients were awaiting surgery on the lower extremity. Delayed surgery patients scored significantly lower than population norms on the SF12-PCS (mean 39.4, CI 36.8-42.1, p<0.001). Males scored significantly higher than females on the SF12-MCS (53 vs 45.1, p=0.003), but the overall mean was not significantly different from the general population (47.2, p=0.08). The mean PSE score was significantly higher than population norms (57.9, CI 56.3-59.6, p<0.001), but did not differ by age or sex. Those with a history of mental health conditions reported higher PROMIS-PSE scores compared to those without (61.2 vs 56.9 p=0.02). Patients who reported being extremely concerned about their surgical delay had lower scores on the SF-PCS and SF-MCS, and higher scores on the PROMIS-PSE (p=0.03, p=0.01, and p<0.001 respectively), suggesting more significant physical and emotional symptoms. The majority of patients indicated that their physical and emotional symptoms were attributed mostly to their injury awaiting surgery, with patients reporting a median 50% attribution (IQR, 32-75%), compared to attributions for COVID or other concerns. The biggest concern with COVID-related surgical delays was a concern about not being back in time for a sports season. Conclusions: Young sports medicine patients reported significant physical and emotional symptoms associated with COVIDrelated surgical delays. Patients were most concerned about delays resulting in missed sport seasons. Those who reported greater levels of concern with surgical delays demonstrated lower physical and mental health scores and higher levels of psychological stress. The physical and psychological impact of surgical delays should be considered when caring for young athletes.