What is the psychology of using or NOT using autograft to repair an anterior cruciate ligament? A new study looked at this interesting question and found evidence that athletes who undergo Bridge-Enhanced anterior cruciate ligament (ACL) repair are more psychologically ready to return to sport 6 months post-surgery than those who have autograft ACL reconstruction instead.
What’s the Psychology of NOT Using Autograft? Study Has Answers
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Secondary#returntosport#anteriorcruciateligamentinjuries#psychologicalreadiness
The study, “Psychological Readiness To Return To Sport At 6 Months Is Higher After Bridge-Enhanced ACL Repair Than Autograft ACL Reconstruction,” was published online on May 13, 2022, in the Orthopaedics Journal of Sports Medicine. The findings were also presented at the 2022 Pediatric Research in Sports Medicine 9th Annual Meeting.
“Prior clinical studies have shown that psychological factors have a significant effect on an athlete’s readiness to return to sport following ACL reconstruction,” the researchers wrote.
In their study the authors of the study compared levels of psychological readiness for return to sport between patients who underwent Bridge-Enhanced ACL Repair and those who underwent ACL reconstruction.
One hundred patients were randomized to either Bridge-Enhanced ACL Repair (n = 65) or autograft ACLR (n = 35). All the patients were treated within 45 days of injury.
The researchers collected objective, functional, and patient-reported outcome data, including the ACL-Return to Sport After Injury scale at 6 months, 12 months, and 24 months.
Patients who underwent Bridge-Enhanced ACL Repair had higher return-to-sport rates at 6 months compared to those with autograft ACL Reconstruction (71.1 vs. 58.2, p = .008). The scores were also similar at 12 months and 24 months.
Baseline factors independently predictive of higher ACL Return to Sport After Injury scores at 6 months were having a Bridge-Enhanced ACL Repair procedure and participating in Level 1 sports prior to injury. This explained 15% of the variability in ACL-Return to Sport After Injury scores.
Decreased pain, increased hamstring, and quadriceps strength in the surgical limb, and decreased side-to-side difference in AP knee laxity were all significant predictors of a higher ACL-Return to Sport After Injury score at 6 months.
Overall, patients who underwent the Bridge-Enhanced ACL Repair procedure had higher ACL-Return to Sport After Injury scores, the researchers reported.
Study authors included Ryan M. Sanborn, B.A., Yi-Men Yen, M.D., Ph.D., Martha M. Murray, M.D., Melissa A. Christino, M.D., Benedikt Proffen, Nicholas Sant, Samuel Barnett, Dennis E. Kramer, and Lyle J. Micheli, all of Boston Children’s Hospital, and Gary J. Badger, M.S., of the University of Vermont. Braden C. Fleming of Brown University/Rhode Island Hospital also contributed to the study.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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