The benefits of intraoperative virtual reality distraction in anterior cruciate ligament reconstruction (ACLR) under spinal anaesthesia.

Patient anxiety in anterior cruciate ligament reconstruction (ACLR) is a preventable potential risk factor for poor patient satisfaction and surgical outcomes. This study aimed to assess the impact of virtual reality (VR) on the anxiety of patients undergoing ACLR under spinal anaesthesia (SA). The primary outcome was the perioperative patient anxiety level as assessed by the State-Trait Anxiety Inventory (STAI-Y1) score. A prospective randomised controlled study, of a single-centre series of patients undergoing ACLR + Lemaire lateral extra-articular tenodesis (LET) under SA, was conducted. Patients were randomised into two groups: Group 1 was a control group, where standard ACLR was performed, and Group 2 had ACLR performed with VR headset used. Pre- and postoperative VAS pain, comfort and anxiety were recorded. Additionally, pre-and postoperative patient anxiety was recorded by the State-Trait Anxiety Inventory (STAI) Score. STAI-Y1 score form was used, which assesses the state (current) level of anxiety. Intraoperative adverse events were recorded including sedation requirements and rescue analgesia and patient postoperative satisfaction was recorded. A total of 60 patients underwent ACLR + LET under SA. Patients were randomised into 2 groups: Group 1 (n = 30), the control group, had standard ACLR performed. Group 2 (n = 30) had ACLR with the use of the VR headset. There was no difference in the mean age and mean BMI between the two groups (p > 0.05). Intraoperatively, less rescue analgesia and less required sedation were encountered in the VR group compared to the control group, 13.3% versus 36.7% (p = 0.03), and 10% versus 56.7% (p < 0.0001), respectively. There was no significant difference in preoperative anxiety between both groups either on the VAS or STAI-Y1 scores (both p = 0.8). The preoperative STAI-Y1 score was 33.3 ± 7.9 in the control group versus 34.9 ± 9.7 in the VR group (p = 0.8). Intraoperatively, there was significantly less anxiety STAI-Y1 score in the VR group of 29.6 ± 7.3 compared to the control group at a score of 36.9 ± 5.8 (p < 0.0001). This continued to be the case in the immediate postoperative period, with significantly lower anxiety score STAI-Y1 in the VR group versus the control group, 30.6 ± 6.9 versus 37.3 ± 5.7, respectively (p < 0.0001). High VAS satisfaction assessed by both the anaesthesiologist and anaesthetic nurse was reported in the VR group versus the control group, 80% versus 36.7% and 93.3% versus 46.7% (all p < 0.0001). VAS pain score was significantly less in the VR group compared to the control group; 2.3 ± 2.1 versus 3.1 ± 2.9 (p = 0.03) in the recovery room, and 2.9 ± 2.7 versus 3.4 ± 3 (p = 0.04) before discharge to home. Virtual reality-augmented anterior cruciate ligament reconstruction results in significantly fewer intraoperative adverse events, significantly less intraoperative and less immediate postoperative patient's anxiety, and higher overall patient satisfaction when assessed by the anaesthetic team. Level I, randomised controlled trial.