Attention-Deficit/Hyperactivity Disorder in Anterior Cruciate Ligament Reconstruction Patients ≤25 Years of Age: A National Database Study of Prevalence and Outcomes.

BACKGROUND: A growing body of research indicates that psychiatric conditions put patients at risk for worse outcomes after anterior cruciate ligament (ACL) reconstruction. However, attention-deficit/hyperactivity disorder (ADHD) is an understudied comorbidity in patients undergoing ACL reconstruction. METHODS: Using the PearlDiver national database, we conducted a retrospective review of 9,352 patients ≤25 years who underwent isolated ACL reconstruction during the period 2010 to 2023. We compared demographics, comorbidities, and outcomes between patients with and without an ADHD diagnosis before and after 1:3 propensity score matching. We also performed a subgroup analysis of ADHD patients who were on and off medication. RESULTS: On average, patients with ADHD were younger than patients without ADHD (P<0.001); were significantly more likely to be male; and had increased rates of obesity, alcohol use disorders, anxiety disorders/depression, tobacco use, and developmental disorders (all P<0.001). Postoperatively, we found no differences in rates of 90-day readmission or in 2-year prolonged opioid use, repeat ACL reconstruction, other knee surgery, or stiffness either before or after propensity score matching. Among the patients with ADHD, 420 (67.9%) filled a prescription for ADHD medication in the 90 days prior to ACL reconstruction. No significant differences were detected in 90-day or 2-year outcomes between patients who used ADHD medication and those who did not. CONCLUSION: In this retrospective database study, 6.6% of patients ≤25 years who underwent ACL reconstruction had a diagnosis of ADHD prior to surgery. Neither a diagnosis of ADHD nor ADHD medication use was associated with worse outcomes after ACL reconstruction. Given the high prevalence of ADHD, further study of its effects on outcomes of ACL reconstruction and other orthopedic conditions is needed.