Patient-specific psychological characteristics and personality structure affect functional outcomes after surgical stabilization of acute and chronic acromioclavicular joint injuries.

PURPOSE: The purpose of the study was to evaluate the impact of psychological factors on functional outcomes of patients undergoing isolated acromioclavicular joint (ACJ) stabilization for acute and chronic ACJ injuries.

METHODS

Patients who underwent ACJ stabilization between January 2015 and December 2021 and had a minimum follow-up of 2 years were analysed. Functional outcome measures included Constant-Murley (CM), American Shoulder and Elbow Surgeons (ASES), Nottingham Clavicle (NC) scores and the Visual Analogue Scale (VAS) for pain. Patient-specific psychological characteristics and personality structure were evaluated using the Tampa Scale of Kinesiophobia (TSK), General Self-Efficacy Short Scale-3 (GSE-3), Big Five Inventory Scale (BFI), Revised Life Orientation Test (LOT-R) and Pain Catastrophizing Scale (PCS). Psychological readiness to return to sport was assessed with the ACJ-Return to Sport after Injury (ACJ-RSI) scale.

RESULTS

A total of 142 patients (mean age at surgery: 39.2 ± 13.7 years; 93 acute and 49 chronic injuries) with a mean follow-up of 6.0 ± 2.2 years were included in the study. Patients had a mean CM of 85.2 ± 13.1, ASES of 93.0 ± 13.1, NC of 86.0 ± 13.8, VAS for pain of 2.0 ± 1.4 and ACJ-RSI of 75.0 ± 23.7 at final follow-up. The CM, ASES and NC scores were negatively correlated with the TSK (ρ = -0.30; ρ = -0.46; ρ = -0.35; P < 0.001, respectively) and the PCS (ρ = -0.32; ρ = -0.42; ρ = -0.30; P < 0.001, respectively), while for the GSE-3 a positive correlation was observed (ρ = 0.32; ρ = 0.40; ρ = 0.42; P < 0.001, respectively). LOT-R for optimism was positively correlated with ASES (ρ = 0.29; P = 0.001) and NC (ρ = 0.27; P = 0.003), while LOT-R for pessimism was only negatively correlated with ASES (ρ = -0.20; P = 0.043). Regarding the BFI, neuroticism was negatively correlated with ASES (ρ = -0.24; P = 0.008), CM (ρ = -0.22; P = 0.017) and NC (ρ = -0.23; P = 0.013).

CONCLUSION

Patient-specific psychological characteristics and personality structure significantly affect functional outcomes after arthroscopically assisted ACJ stabilization for acute and chronic ACJ injuries at mid-term follow-up. Functional outcome scores were positively correlated with the patients' self-efficacy and optimistic outlook on life, while for kinesiophobia, catastrophizing of pain and neuroticism, a negative correlation was observed.

LEVEL OF EVIDENCE: Level IV retrospective study.