Baseline Measures of Psychology and Mental Health Among Patients Undergoing ACLR: An IMPACT Cohort Study- SOMOS 2025

d cognetti, a sheean

Abstracted accepted for a rapid-fire presentation at the 2025 Society of Military Orthopaedic Surgeons Annual Meeting.

INTRODUCTION: ACL reconstruction (ACLR) remains the cornerstone of management of ACL injuries among young, active individuals. However, rates of return to pre-injury activity after ACLR remain unacceptably low among certain cohorts, particularly Service Members. Patient psychology may affect the outcomes of ACLR, and multiple reports have suggested that patients’ general mental health and resilience may play a significant and understudied role in the functional outcomes of ACLR. However, we are unaware of any reports that have described the distribution of resilience scores among a cohort of relatively young, active individuals undergoing ACLR. The Investigation into Mental Processes and Clinical Therapies (IMPACT) Study Group’s prospective observational cohort study was created to study the baseline psychological characteristics of patients undergoing ACLR and the effects of patient psychology on outcomes of ACLR.  Therefore, the purposes of this prospective analysis were to 1. Describe the distribution of baseline resilience scores among a large cohort of patients undergoing ACLR, 2. Assess for differences in baseline resilience between males and females undergoing ACLR, and 3. Describe the correlation between measures of patient psychology and general mental health. We hypothesized that women undergoing ACLR would be more likely to report lower resilience and that worse baseline mental health would be associated with lower resilience.

METHODS: Between 2023 and 2025, patients with ACLR were prospectively enrolled across an eight-site multicenter (5 civilian sites, 2 military medical treatment facilities) network. All enrolled patients completed a battery of patient reported outcome measures (PROMs) prior to ACLR. Continuous variables were summarized using medians and interquartile ranges (IQR.) Pearson’s correlation was calculated to assess the correlation between baseline resilience score, as assessed with Connor Davidson Resilience Scale (CD-RISC 10) and general mental health as measured by the Patient Reported Outcome Measurement Information System (PROMIS) Mental Health Score. Data management and data analysis were performed using SPSS Statistics software (Version 30; Chicago, IL). Correlations were two-sided, with an alpha level of 0.05.

RESULTS: One thousand sixty-one patients (541 males [50.6%], 528 males [49.4%]; median age 26.0 years (IQR 19.0, 37.0) were included in the final analysis. The cohort baseline median MARX activity score was 11.0 (IQR: 1.0, 16.0), PROMIS Physical Function (PF) 15.0 (IQR: 14.0, 17.0), PROMIS Mental Health (MH) 16.0 (IQR: 14.0, 18.0.) The median CD-RISC 10 was 32.0 (IQR: 29.0, 38.0.) Correlational analysis between biological sex and continuous study outcomes indicated that, compared to males, female subjects reported significantly lower physical activity level (r= 0.77, P = 0.021), worse mental health r= 0.79, P = 0.024), and more pain at baseline (r = -0.073, P = 0.017). No other significant differences in continuous study variables were identified between males and females. Regardless of biological sex, there was moderate positive correlation between baseline mental health and resilience (r = 0.547, P = 0.01.)

DISCUSSION and CONCLUSION: There was no difference in baseline resilience between males and females undergoing ACLR. Among the entire cohort, significant differences in multiple baseline measures were noted between males and females. In describing the distribution of resilience scores among a large population of patients undergoing ACLR, the current study will inform future, interventional trials to target modifiable risk factors for worse clinical outcomes of ACLR. We are unaware of comparably sized cohort focused specifically on patient psychology and outcomes of ACLR in the published literature.