| Abstract ID |
| 20260115 |
| Category |
| Knee: ACL |
| Preferable Presentation |
| Both |
| Title |
| HIGH PREOPERATIVE ANXIETY IS ASSOCIATED WITH DELAYED EARLY RECOVERY AND INFERIOR QUADRICEPS SYMMETRY AT 3 MONTHS POST-ACLR |
| Author |
|
| Presenter |
| HAO DUAN |
| Abstract |
| Background Preoperative anxiety has been recognized as a contributor to increased acute pain following anterior cruciate ligament reconstruction (ACLR). However, its influence on the trajectory of early recovery—including pain resolution and range of motion (ROM) progression—and its subsequent impact on short-term functional outcomes remain insufficiently explored. Objectives To investigate whether high preoperative anxiety affects early pain trajectories, ROM recovery, and 3-month functional outcomes (Lysholm, IKDC, isometric strength) after primary ACLR. Study design A total of 76 patients undergoing primary unilateral ACLR with a standardized rehabilitation protocol were enrolled. Based on preoperative Surgical Fear Questionnaire (SFQ) scores, participants were categorized into high anxiety (SFQ ≥ 30, n = 42) and low anxiety (SFQ < 30, n = 34) groups. Preoperative assessments included SFQ, Lysholm, IKDC, and Tegner scores. Postoperatively, pain was evaluated daily using a visual analogue scale (VAS) for the first three days, and again at 1 week and 1 month. Active knee flexion and extension ROM were measured at 1 week and 1 month. Isometric quadriceps and hamstring strength were assessed using hand-held dynamometry at 1 and 3 months, along with Lysholm and IKDC scores at 3 months. Non-parametric tests were employed for between-group comparisons, and effect sizes were calculated. Mixed models with bootstrapped confidence intervals were used to analyze pain trajectories. Results All 76 patients completed the 3-month follow-up. While the high anxiety group exhibited slightly lower preoperative Lysholm scores, analyses adjusted for this baseline difference.The high anxiety group exhibited higher VAS scores at most early time points, with a trend toward slower pain resolution (interaction p = 0.08; effect size at day 3: d = 0.5). Active knee flexion was lower in the high anxiety group at 1 week (median [IQR]: 86° [80–92] vs. 94° [88–100], p = 0.02, r = 0.3) and at 1 month (106° [100–112] vs. 114° [108–120], p = 0.04, r = 0.25). At 1 month, isometric quadriceps strength symmetry was reduced in the high anxiety group (52% [46–58] vs. 61% [55–67], p = 0.02, r = 0.3). At 3 months, patients with high preoperative anxiety demonstrated lower Lysholm scores (68 [63–72] vs. 75 [71–79], p = 0.01, r = 0.3) and quadriceps strength symmetry (62% [56–68] vs. 69% [64–75], p = 0.008, r = 0.35). IKDC scores at 3 months also favored the low anxiety group, though the difference did not reach statistical significance (p = 0.07, r = 0.2). Conclusion High preoperative anxiety is associated with delayed early ROM recovery, slower pain resolution, and inferior short-term functional outcomes and quadriceps strength symmetry following ACLR. Routine preoperative psychological screening and targeted interventions should be considered within comprehensive ACL rehabilitation protocols to optimize early recovery trajectories. |