Patients With Low Resilience Scores Have Significantly Worse Postoperative Outcomes After Anterior Cruciate Ligament Reconstruction Than Patients With Normal or High Resilience Scores

Matthew Meade; Brian Fliegel; Patrick Szukics; Elizabeth Ford; Manuel Pontes; Sean McMillan

doi:10.1016/j.asmr.2023.03.009

Patients With Low Resilience Scores Have Significantly Worse Postoperative Outcomes After Anterior Cruciate Ligament Reconstruction Than Patients With Normal or High Resilience Scores

Arthrosc Sports Med Rehabil. 2023 May 8;5(3):e679-e685. doi: 10.1016/j.asmr.2023.03.009. eCollection 2023 Jun.

Authors

Matthew Meade¹, Brian Fliegel¹, Patrick Szukics¹, Elizabeth Ford², Manuel Pontes³, Sean McMillan⁴

Affiliations

¹ Division of Orthopaedic Surgery, Jefferson Health - New Jersey, Stratford ,New Jersey, U.S.A.
² Division of Orthopaedic Surgery, Inspira Health Network, Vineland, New Jersey, U.S.A.
³ Division of Marketing, Rowan University, Stratford, New Jersey, U.S.A.
⁴ Division of Orthopaedic Surgery, Virtua Medical Center, Burlington, New Jersey, U.S.A.

Abstract

Purpose: To evaluate the relationship between patient resilience and patient-reported outcome measures (PROMS) after primary anterior cruciate ligament (ACL) reconstruction.

Methods: Patients who underwent an ACL reconstruction by a single surgeon between January 2012 and June 2020 were identified by an institutional query using Current Procedural Terminology codes. Patients were included if they (1) underwent a primary ACL reconstruction and (2) had a minimum of 2 years' follow-up. Data were retrospectively collected regarding demographics, surgical details, visual analog scale (VAS) scores, and 12-item short form survey (SF-12) scores. Resilience scores were obtained via the Brief Resilience Scale questionnaire. Stratification into low (LR), normal (NR), and high resilience (HR) was based on standard deviation from mean Brief Resilience Scale score to determine differences in PROMS between groups.

Results: One-hundred eighty-seven patients were identified by the institutional query. Of the 187 patients, 180 met inclusion criteria. Seven patients underwent revision ACL reconstruction and were excluded from the study. One-hundred three patients (57.2%) completed the postoperative questionnaire and were included. Patients in the NR group and HR group had significantly greater postoperative SF-12 scores (P < .001) and lower postoperative VAS pain scores (P < .001) when compared with those of the LR group. This trend was again shown with breakdown of the SF-12 into physical and mental aspects, each of which were significantly greater in either the NR group or HR group when compared with the LR group (P < .001). Overall, 97.9% and 99.0% of patients had changes in their SF-12 total and VAS pain scores respectively that exceeded the minimal clinically important difference for the cohort.

Conclusions: Patients with lower resilience scores have worse PROMs and increased pain than patients with greater resilience at a minimum of 2-year follow-up after ACL reconstruction.

Level of evidence: Level IV, prognostic case series.