Self-Reported Symptoms of Depression and Anxiety After ACL Injury: A Systematic Review

Ramana Piussi; Tora Berghdal; David Sundemo; Alberto Grassi; Stefano Zaffagnini; Mikael Sansone; Kristian Samuelsson; Eric Hamrin Senorski

doi:10.1177/23259671211066493

Self-Reported Symptoms of Depression and Anxiety After ACL Injury: A Systematic Review

Orthop J Sports Med. 2022 Jan 18;10(1):23259671211066493. doi: 10.1177/23259671211066493. eCollection 2022 Jan.

Authors

Ramana Piussi^{1

2}, Tora Berghdal², David Sundemo^{2

3}, Alberto Grassi⁴, Stefano Zaffagnini⁴, Mikael Sansone², Kristian Samuelsson², Eric Hamrin Senorski^{1

5

2}

Affiliations

¹ Sportrehab Sports Medicine Clinic, Gothenburg, Sweden.
² Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.
³ Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁴ Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
⁵ Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Abstract

Background: Depression and anxiety symptoms can occur in patients following an anterior cruciate ligament (ACL) injury, and the presence of these symptoms has been associated with poorer self-reported knee function in this type of injury.

Purpose: To investigate the prevalence and severity of self-reported symptoms of depression and anxiety following an ACL injury.

Study design: Systematic review; Level of evidence, 4.

Methods: PubMed, Cochrane Library, Embase, PsycINFO, AMED, and PEDro databases were searched using a combination of keywords relating to ACL, depression, anxiety, and their synonyms. Inclusion criteria were clinical studies written in English that reported on patients with an injured and/or reconstructed ACL and assessed symptoms of depression and/or anxiety. Data extraction was performed independently by 2 authors. Data synthesis was performed using an emergent synthesis approach. The quality of the included studies was assessed using the methodological index for non-randomized studies or the Mixed-Methods Appraisal Tool. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation.

Results: After abstract screening, 37 studies were assessed in full text, of which 16 were included. The studies comprised 682 patients (417 male [61%]). The depression symptoms appeared to be more severe in elite athletes compared with recreational athletes. Symptoms decreased over time from moment of ACL reconstruction to up to 2 years postoperatively. The prevalence of self-reported symptoms of anxiety after an ACL injury was reported in 1 study (2%). There were no differences in anxiety symptoms between professional and amateur athletes or between adolescents and adults. The overall quality of the studies was low or very low.

Conclusion: Patients who sustain an ACL injury can suffer from symptoms of depression, especially during the first 6 weeks after ACL reconstruction. Depressive symptoms are more common among professional versus nonprofessional athletes. Levels of anxiety symptoms were not above the cutoffs for a diagnosis of anxiety after an ACL injury.

Keywords: anterior cruciate ligament; depressive disorder; knee; psychology; reconstruction.

Publication types

Review