Children's Orthopaedics of Atlanta, Atlanta, Georgia, USA.
Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Orthop J Sports Med. 2016 Mar 23;4(3):2325967116638341. doi: 10.1177/2325967116638341. eCollection 2016 Mar.
Psychological factors may have underappreciated effects on surgical outcomes after anterior cruciate ligament (ACL) reconstruction; however, few studies have investigated the relationship between specific psychological factors, objective clinical data, and patient-oriented outcomes.
Psychological factors are significantly associated with patient perceptions and functional outcomes after ACL reconstruction. The purpose of this study was to demonstrate relationships between self-esteem, health locus of control, and psychological distress with objective clinical outcomes, patient-oriented outcomes, and return to sport.
Cross-sectional study; Level of evidence, 3.
Twenty-seven patients who were 6 to 24 months post-computer-assisted ACL reconstruction by a single surgeon consented to participate in the study (52% response rate). Participants had a 1-time visit with a physician consisting of: a physical examination, a single-leg hop test, KT-1000 arthrometer measurements, and survey completion. Psychological measures included the Multidimensional Health Locus of Control Scale, Rosenberg Self-Esteem Scale, and Brief Profile of Mood States. Outcome measures included the Tegner activity scale, International Knee Documentation Committee (IKDC) Subjective Knee Score, Knee injury and Osteoarthritis Outcome Score-Quality of Life subscale (KOOS-QOL), and Short Form-36 (SF-36). Patient charts were also reviewed for pertinent operative details.
The mean age of patients (±SD) was 25.7 ± 8.4 years, and the mean duration of time since surgery was 16.5 ± 5.9 months. The majority (89%) of the patients identified themselves as athletes, and of these, 65% reported returning to sports at a competitive level. Sport returners were found to have higher levels of self-esteem (P = .002) and higher reported KOOS-QOL scores (P = .02). Self-esteem was significantly associated with IKDC scores (r = 0.46, P < .05), KOOS-QOL scores (r = 0.45, P < .05), and SF-36 subscales of general health (r = 0.45, P < .05) and physical functioning (r = 0.42, P < .05). Internal locus of control was significantly correlated with performance on single-leg hop test (r = 0.4, P < .05). Objective knee stability measurements did not correlate with subjective outcomes.
Self-esteem levels and locus of control had significant relationships with functional test performance and validated outcome measures after ACL reconstruction. Sport returners had significantly higher self-esteem levels than those who did not return to sports, without observable differences in knee stability or time since surgery.
心理因素可能对前交叉韧带（ACL）重建后的手术结果产生被低估的影响；然而，很少有研究调查特定心理因素、客观临床数据和以患者为中心的结果之间的关系。
心理因素与 ACL 重建后患者的感知和功能结果显著相关。本研究的目的是证明自尊、健康控制源和心理困扰与客观临床结果、以患者为中心的结果以及重返运动之间的关系。
横断面研究；证据水平，3 级。
27 名患者在同一位外科医生的帮助下接受了计算机辅助 ACL 重建，术后 6 至 24 个月，有 52%（52%的回复率）的患者同意参与研究。参与者接受了一次由医生进行的检查，包括：体格检查、单腿跳跃测试、KT-1000 关节测量仪测量和问卷调查。心理测量包括多维健康控制源量表、罗森伯格自尊量表和简明心境量表。结果测量包括 Tegner 活动量表、国际膝关节文献委员会（IKDC）主观膝关节评分、膝关节损伤和骨关节炎结局评分-生活质量量表（KOOS-QOL）和简明健康调查问卷 36 项（SF-36）。患者病历还回顾了相关手术细节。
患者的平均年龄（±SD）为 25.7±8.4 岁，手术时间平均为 16.5±5.9 个月。大多数（89%）患者自认为是运动员，其中 65%报告以竞技水平重返运动。研究发现，运动恢复者的自尊水平更高（P=.002），KOOS-QOL 评分更高（P=.02）。自尊与 IKDC 评分（r=0.46，P<.05）、KOOS-QOL 评分（r=0.45，P<.05）和 SF-36 一般健康（r=0.45，P<.05）和身体功能（r=0.42，P<.05）子量表显著相关。内部控制源与单腿跳跃测试的表现显著相关（r=0.4，P<.05）。客观的膝关节稳定性测量与主观结果无关。
自尊水平和控制源与 ACL 重建后的功能测试表现和经过验证的结果测量有显著关系。运动恢复者的自尊水平明显高于未恢复运动的患者，而膝关节稳定性或手术时间无明显差异。
