ADHD Emerges as Overlooked Risk Factor in ACL Surgery Outcomes
Medical Students Link ADHD to Higher Risk of Revision Surgery and Underscore the Need for Tailored Postoperative Care
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Anterior cruciate ligament (ACL) tears make up more than half of all knee injuries in the United States, affecting more than 120,000 people each year. Typically treated with surgical reconstruction, successful recovery relies heavily on adherence to post-operative rehabilitation. A study by New York Medical College medical students, published in Sports Health: A Multidisciplinary Approach, found that patients with attention-deficit/hyperactivity disorder (ADHD) face a higher risk of requiring revision surgery and other complications.
“While mental health conditions such as depression and anxiety have been increasingly examined in relation to orthopedic surgery outcomes, ADHD has remained largely overlooked,” says Jared Sasaki, SOM Class of 2027, the lead author of the study. “Given the rising prevalence of ADHD diagnoses over the past several decades, and particularly following the COVID-19 pandemic, this study addresses a critical gap in the literature on how ADHD may affect surgical recovery.”
Rehabilitation after ACL reconstruction, which includes therapies like resistance training, neuromuscular exercises, dynamic functional tasks, and task-specific training, requires careful attention to detail and consistent effort. The core features of ADHD, inattention, impulsivity, and hyperactivity, can make adherence to these therapies increasingly challenging.
The study examined patient outcomes up to three months, six months, and three years postoperatively. ADHD patients up to six months postoperatively were found to have a significantly increased risk of requiring revision surgery, having wound complications, and experiencing hospital readmission compared with the non-ADHD group. ADHD patients were also more likely to return to the emergency department within six months.
“These findings emphasize the importance of considering ADHD as a factor in orthopedic surgery outcomes and recovery,” says Sasaki.
Optimizing postoperative care for patients with ADHD remains an important challenge. A follow-up study by Sasaki and his fellow researchers, published in The Journal of the American Academy of Orthopaedic Surgeons, found that ADHD patients treated with stimulant medications experienced few complications, including lower rates of arthrofibrosis (chronic stiffness and knee pain), potentially due to better adherence to rehabilitation and more effective participation in physical therapy.
“It is our hope that these findings will encourage clinicians to consider ADHD in individualized postoperative care strategies aimed at improving adherence to rehabilitation and ultimately enhancing patient outcomes. For patients, greater awareness of these risks may foster more consistent participation in recovery and better long-term results.”
