Poster 27. Virtual Cognitive Behavioral Therapy to Improve Anterior Cruciate Ligament Reconstruction Outcomes: A Preliminary Analysis of a Randomized Controlled Trial

This is the authors' abstract. We don't add key points for this paper.

Objective: The importance of psychology on anterior cruciate ligament reconstruction (ACLR) recovery is becoming increasingly understood. Psychological barriers such as fear of reinjury, low confidence, and depressive symptoms have been shown to play an important role in return to play (RTP) after ACLR. While most rehabilitation and return to sport programs address the musculoskeletal aspects of recovery, few address the psychological recovery of ACLR. The purpose of our study is to assess whether a novel virtual psychological intervention (VPI) incorporating cognitive based therapy (CBT) improves postoperative outcomes after ACLR compared to our standard of care. Methods: A total of 97 patients were assessed for eligibility. We performed a randomized controlled trial in accordance with the CONSORT (Consolidated Standards of Reporting Trials) 2010 statement. The study arms were an experimental cohort who received a novel VPI program consisting of eight asynchronous CBT modules targeting psychoeducation, relaxation, and fear of reinjury to be started before surgery and continued for 52 weeks in addition to the standard postoperative rehabilitation compared to a control cohort. Primary outcome was ACL Return to Sport after Injury (ACL-RSI) scores and secondary outcomes included Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) and Physical Function (PF) scores, Patient Health Questionaire-2 (PHQ-2), Tampa Scale for Kinesiophobia (TSK), and visual analog scale (VAS) pain scores. Outcomes were assessed preoperatively, at two weeks, and at three months postoperatively. Results: A total of 69 patients were randomized with 16 patients in the VPI cohort and 23 patients in the control cohort. Mean age, sex, history of mental health, and additional procedures were similar between cohorts. At preoperative, two weeks, or three months postoperative, no significant differences were found between cohorts amongst ACL-RSI, PROMIS-PF, PROMIS PI, TSK, and VAS scores. Between preoperative and three months postoperatively, no significant differences were found between cohorts in mean change in ACL-RSI, PROMIS-PF, PROMIS PI, TSK, and VAS scores. Conclusions: This is the first use of a novel VPI adjunct to traditional physical therapy after ACLR. We found no significant difference in short-term patient recorded outcomes amongst patients utilizing a virtual CBT-based intervention compared to a control cohort. These findings support existing evidence that non-individualized virtual psychological interventions offer limited benefit in the short term. Future research is needed on personalized, multidisciplinary approaches with longer follow-up to better support psychological readiness and functional recovery.