The Hong Kong Journal of Sports Medicine and Sports

Volume XV, November 2002
Abstract

Presurgical Anxiety, Concerns, and Anticipated Benefits Associated with Anterior Cruciate Ligament Reconstruction

BRITTON W. BREWER, ALLEN E. CORNELIUS, JUDY L. VAN RAALTE, AND
ALBERT J. PETITPAS
Springfield College, U.S.A.

JOSEPH H. SKLAR, MARK H. POHLMAN, AND ROBERT J. KRUSHELL
New England Orthopedic Surgeons, U.S.A.

TERRY D. DITMAR
Apex Rehabilitation of Western New England, U.S.A.

JEFFREY P. RICE
Brandeis University, U.S.A.

KENNETH TUBILLEJA
Springfield College, U.S.A.

This study examined factors associated with preoperative anxiety, preoperative concerns, and anticipated benefits of surgery in 72 patients (50 men and 22 women) scheduled to undergo anterior cruciate ligament (ACL) reconstruction. General psychological distress was inversely related to presurgical anxiety and previous orthopedic surgery experience was positively associated with presurgical anxiety. Content analyses performed on responses to open-ended questions regarding concerns and anticipated benefits revealed several predominant themes. The presurgical concerns identified most frequently pertained to general postsurgical physical limitations, short-term surgical aftereffects, recovery duration, and postsurgical sport activity limitations. The anticipated benefits of surgery listed most frequently were improvements in general physical functioning, functioning in sport activities, mental state, and functioning in daily activities. The results suggest that previous surgical experience sensitizes patients to aversive aspects of surgery and heightens presurgical anxiety. This information, along with knowledge of patient perceptions of concern and benefit associated with ACL reconstruction, may be useful in developing presurgical psychoeducational interventions.

Physical injury is a common occurrence in association with involvement in sport and physical activity (Booth, 1987; Bijur et al., 1995; Caine, Caine, & Lindner, 1996; Uitenbroek, 1996). A torn anterior cruciate ligament (ACL) of the knee is one of the more prevalent and debilitating injuries incurred during sport participation (Derscheid & Feiring, 1987). Reconstructive surgery is considered the treatment of choice for young, active individuals who sustain ACL tears (Marzo & Warren, 1987).

Although the physical aspects of ACL reconstruction are well-documented (Fu, Bennett, Lattermann, & Ma, 1999; Fu, Bennett, Ma, Menetrey, & Lattermann, 1999), little is known about psychological aspects of the surgical procedure. In particular, research has not addressed the presurgical psychological state of prospective ACL reconstruction patients. Although innovations in surgical techniques, analgesia, and rehabilitation have greatly reduced the postsurgical recovery period, people undergoing ACL reconstructive surgery can still expect to experience some pain and discomfort during the postoperative and rehabilitative phases (Shelbourne & Wilckens, 1990). Accordingly, individuals may experience anxiety or apprehension prior to ACL reconstruction.

In contemporary models of psychological response to sport injury (Wiese-Bjornstal, Smith, Shaffer, & Morrey, 1998), the emotional reactions of athletes with injuries are considered to be affected by both personal and situational variables. One situational factor that may influence how anxious people are about their ACL surgery is previous surgical experience. Having had surgery previously may allow prospective ACL reconstruction patients to form accurate, information-based impressions of surgery that minimize anxiety (Suls & Wan, 1989). In support of this notion, Badner, Nielson, Munk, Kwiatkowska, and Gelb (1990) found that surgery patients who had not previously had anaesthesia reported greater preoperative anxiety than those who had had anaesthesia. Conversely, previous surgical experience may also sensitize individuals to aversive aspects of surgery, thereby heightening presurgical anxiety (Langer, Janis, & Wolfer, 1975).

Anxiety associated with ACL surgery may also be affected by patients' general level of psychological distress. Patients experiencing greater general psychological distress may be more likely than patients with lower levels of general psychological distress to experience preoperative anxiety. The primary purpose of this study was to examine the extent to which orthopedic surgery experience, general psychological distress, and two personal factors (i.e., age and gender) were related to surgery-specific anxiety prior to ACL reconstruction. In an attempt to better understand the preoperative psychological state of ACL reconstruction patients, a secondary purpose of the study was to examine the concerns and anticipated benefits associated with ACL reconstructive surgery.

Key Words: Knee, injury, operation.


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