Poster 353: LOWER PSYCHOLOGICAL READINESS FOR RETURN TO SPORT AFTER ACL RECONSTRUCTION IS ASSOCIATED WITH REDUCED PERFORMANCE AND GREATER LIMB ASYMMETRY ON FUNCTIONAL TESTING

Objectives: The relationship between psychological and physical readiness for return to sport after anterior cruciate ligament reconstruction (ACLR) is not well understood. Psychological stress and psychological readiness were therefore evaluated at six months following primary ACLR along with standard functional patient reported outcome (PRO) instruments and physical performance tests to understand the relationship between the physical and psychological readiness in young athletes. Methods: Participants were evaluated at six months after ACLR with Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS), International Knee Documentation Committee Questionnaire (IKDC), PROMIS Psychological Stress Experience (PSE) and ACL Return to Sport After Injury Scale (ACL-RSI). Functional testing included gluteal, hamstring, and quadriceps strength testing, single leg hop (SLH), crossover hop, triple hop and timed 6-meter SLH. Patient characteristics and continuous and categorical variables were summarized. Pearson’s correlation coefficient and multivariable regression were used to determine associations between the limb symmetry index (LSI) on functional testing and PROs. Those with LSI deficits of less than 20% (better performance) were then compared to those with deficits greater than 20% (worse performance). Results: 229 participants (89 male, 140 female) of median age 17 years (range 10.3 to 30.6 years) were enrolled. IKDC had a moderate negative correlation with PROMIS PSE (r=0.39 ; 95% CI=-0.49, -0.27; p<0.001) and a moderate positive correlation with ACL-RSI (r=0.55; 95% CI=0.46, 0.64; p<0.001) (Figure 1). 151 patients completed functional testing. ACL-RSI demonstrated a positive correlation with SLH LSI (r=0.21;95% CI=0.05, 0.35; p=0.01) and timed 6-meter SLH (r=0.28; 95% CI, 0.42; p=0.001) (Figure 2). When controlling for sex, age, and graft type, patients who had less than a 20% deficit on the SLH scored 17.9 points higher on ACL-RSI (p<0.001), and those with less than a 20% deficit on crossover hop testing scored average 13.9 points higher on ACL-RSI (p=0.04). Conclusions: At 6 months after ACLR, highe r psychological readiness for return to sport is associated with better performance and greater symmetry on hop testing, suggesting a potential link between physical and psychological recovery.