Baseline Resilience and Mental Health in Patients Undergoing ACL Reconstruction: A Multicenter Cohort Study- MHSRS 2026
a sheean, k spinder, m scarcella, d jin, j arner, a athiviraham, s defroda, c nuelle, j ernat, d cognetti, t dekker, l harris
Abstract accepted for poster presentation at the 2026 Military Health System Research Symposium (MHSRS)
INTRODUCTION: Anterior cruciate ligament (ACL) injury is a leading contributor to NMSKI, lost duty days, and limited deployability in Service Members (SMs). Despite advances in ACL reconstruction (ACLR), return-to-duty (RTD) rates remain suboptimal. Psychological factors, including resilience and mental health (MH), may affect recovery and readiness, but baseline resilience (BR) is not well characterized. This study aimed to describe BR, assess sex differences, and examine its relationship with MH, with the hypothesis that females and those with poorer MH would report lower resilience.
METHODS: From 2023–2025, patients undergoing ACLR were prospectively enrolled across an eight-site network (six civilian, two military treatment facilities). Preoperative patient-reported outcome measures included the Connor-Davidson Resilience Scale (CD-RISC-10) and PROMIS Mental Health (MH). Continuous variables are reported as medians (IQR), and Pearson correlations assessed the relationship between resilience and MH. Analyses were conducted in SPSS v30, two-sided, with α=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. Median baseline MARX activity score was 11.0 (IQR: 1.0, 16.0), PROMIS Physical Function (PF) 15.0 (IQR: 14.0, 17.0), PROMIS 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 MH 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 MH and resilience (r = 0.547, P = 0.01.)
DISCUSSION/CONCLUSION: BR did not differ by sex despite differences in other readiness-relevant measures. The association between resilience and MH identifies a potentially modifiable factor influencing recovery trajectories and RTD. Early identification of at-risk individuals may enable targeted psychological interventions to improve functional recovery, reduce limited duty time, and enhance force readiness. These findings support integration of psychological optimization strategies into perioperative care pathways for SMs undergoing ACLR.