Prevalence of, and Factors Associated With, Symptoms of Anxiety and Depression in Young Adults With a Symptomatic Knee After ACL Reconstruction: Results from the SUPER-Knee study

Background: Anterior cruciate ligament (ACL) injury and its lengthy recovery period can lead to adverse mental health outcomes. However, symptoms of anxiety and depression after ACL injury are infrequently investigated. Purpose: To investigate the prevalence of, and factors associated with, symptoms of anxiety or depression in young adults with a symptomatic knee after ACL reconstruction (ACLR). Study Design: Cross-sectional study; Level of evidence, 3. Methods: We analyzed baseline data from 184 adults with a symptomatic knee (defined as a mean score of <80/100 from 4 subscales of the Knee injury and Osteoarthritis Outcome Score [KOOS 4 ]) 9 to 36 months after ACLR who were enrolled in the SUPER-Knee trial (age 30 ± 6 years, 37% women, body mass index [BMI] 27.3 ± 5.2 kg/m 2 ). Symptoms of anxiety or depression were assessed using the “anxiety/depression” item of the EQ5D 5-level questionnaire (EQ5D-5L) (1 = none, 2 = slight, 3 = moderate, 4 = severe, and 5 = extreme). Knee-related burden was assessed with the 5 KOOS subscales (0 = worst, 100 = best). The relationship between anxiety or depression with (1) demographic (age, sex, BMI, preinjury activity level, and socioeconomic status) and injury/surgery-related factors (combined meniscal/cartilage injury, >1 ACLR), and (2) KOOS and return to sports (RTS) was evaluated with ordered logistic regression. Results: A total of 104 (57%) participants reported symptoms of anxiety or depression (slight = 69, moderate = 33, and severe = 2). A higher BMI was the only demographic/injury/surgery-related factor associated with the severity of anxiety or depression symptoms (not anxious/depressed = 26.3 ± 4.5 kg/m 2 , slightly anxious/depressed = 27.7 ± 5.4 kg/m 2 , moderately/severely anxious/depressed = 28.7 ± 6.2 kg/m 2 ). More severe anxiety or depression was associated with worse scores on all KOOS subscales, but not RTS. Conclusion: Over half of adults with knee symptoms 9 to 36 months after ACLR reported anxiety/depression symptoms, and almost 1 in 5 reported moderate to severe anxiety/depression symptoms. Greater severity of anxiety or depression symptoms was associated with overweight/obesity and worse knee-related burden. Mental health outcomes should be monitored after ACLR, and appropriate management and/or referral should be considered. ANZCTR: ACTRN12620001164987.