Patient resilience may not correlate with outcomes after ACL reconstruction
Key takeaways:
- Patient resilience may not be a strong predictor of subjective outcomes after ACL reconstruction.
- Results showed 37% of patients changed resilience groups at 2-year follow-up.
According to published results, patient resilience may not be a strong predictor of patient-reported outcomes after ACL reconstruction, as many patients had changes in resilience levels throughout the course of follow-up.
“We have been doing several research projects looking at the effect of resilience on the outcome of sports medicine surgery, including this article on ACL reconstruction, as well as results of meniscus surgery and rotator cuff repair,” Kevin B. Freedman, MD, MSCE, professor of orthopedic surgery at the Sidney Kimmel College of Medicine and Thomas Jefferson University and director of sports medicine research at the Rothman Institute, told Healio. “Overall, the effect of patients’ resilience on postoperative outcomes has been mixed.”
Freedman and colleagues performed a prospective cohort study of 81 patients (mean age, 32 years) who underwent ACL reconstruction at a single institution between January 2020 and June 2020 and had a minimum follow-up of 2 years.
Freedman and colleagues stratified patients with the Brief Resilience Scale, a routine patient questionnaire that quantifies patients’ preoperative resilience levels. According to the study, 14 patients had low resilience, 54 patients had normal resilience and 13 patients had high resilience.
At 2-year follow-up, 37% of patients (n = 30) changed resilience groups. Freedman and colleagues found 13 patients decreased in resilience and 17 patients increased in resilience. They noted no patients moved from the low resilience group to the high resilience group and one patient moved from the high resilience group to the low resilience group. They also noted 74.1% of the normal resilience group stayed within their group at 2-year follow-up.
Patients in the high resilience group had the highest postoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and single assessment numeric evaluation (SANE) scores compared with patients in the normal and low resilience groups. Postoperative KOOS-JR scores were 94.8, 86.7 and 79.6 in the high, normal and low resilience groups, respectively, while postoperative SANE scores were 92.3, 83.5 and 69.2 in the high, normal and low resilience groups, respectively.
Freedman and colleagues found patients with high preoperative resilience achieved the patient acceptable symptom state (PASS) for IKDC score at a significantly higher rate vs. patients in the normal and low preoperative resilience. However, they found no differences between the groups in achievement of PASS for postoperative VAS or IKDC scores over time.
“In this study, there was some impact of resilience, with higher preoperative resilience leading to better [patient-reported outcomes] PROs on certain scales and not others. In addition, we have found that patient resilience is not static, and our measure of patient resilience changes over time,” Freedman said. “So, either resilience is not static as some would believe or the scales we are using to measure resilience are inadequate. It is an area for additional research to help identify groups at risk for worse surgical outcomes, based on patient factors and less on advanced surgical techniques.”
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