• Kesavan Sadacharam, Kristen Uhl, Stephen Kelleher, Galit Kastner Ungar, Steven Staffa, Joseph Cravero, James Bradley, Matthew D Milewski, Brian Lau, Wallis T Muhly, and SPAIN-ACL Investigators.
• From the Department of Anesthesiology and Perioperative Medicine, Nemours Children's Health, Wilmington, Delaware.
• Anesth. Analg. 2025 Jan 31.

BackgroundAcute orthopedic injuries and subsequent surgical repair can be challenging for children and adolescents and result in posttraumatic stress reactions that can be problematic after the acute perioperative period. In a cohort of patients undergoing anterior cruciate ligament reconstruction (ACLR), we investigated the incidence and explored risk factors associated with the development of posttraumatic stress disorder (PTSD) symptoms after surgery.MethodsWe analyzed data from a multicenter, prospective, observational registry of pediatric patients undergoing ACLR. Patient data included demographic, psychological assessments, postoperative pain measures, and a posttraumatic stress disorder assessment (Child PTSD Symptom Scale [CPSS]) collected after the operation. An analysis of patients who provided survey data at 6 months was used to determine the incidence of posttraumatic stress reactions and to explore associated risk factors.ResultsA total of 519 patients were enrolled in a prospective observational study of outcomes after ACLR. A cohort of 226 patients (44%) provided completed data collection and CPSS follow-up surveys at 6 months. We found that 17 of the patients (7.5%) met the criteria for PTSD at 6 months which represents 3.3% of our total study population (17/519). A univariate analysis suggested that a negative (P = .017), excitable (P = .039), or inhibitory (P = .043) temperament compared to a positive temperament, high preoperative scores for anxiety (P = .001) or depression (P = .019) and high pain scores on postoperative day (POD)1 (P = .02) increased the odds of PTSD at 6 months. A multivariable model revealed that patients self-reporting symptoms consistent with clinical anxiety/depression preoperatively and patients with a max pain score ≥7 on POD1 were 29 times (P = .018) and 9.8 times (P = .018) more likely to develop PTSD at 6 months.ConclusionsA portion of patients undergoing ACLR are at risk for the development of symptoms consistent with PTSD. Risk factors include preoperative anxiety or depression and high postoperative pain scores. Interventions designed to address preoperative risk factors and optimization of postoperative pain may represent opportunities to improve outcomes in this patient population.Copyright © 2025 International Anesthesia Research Society.

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