Association Between Psychological Readiness and Knee Laxity and Their Predictive Value for Return to Sport in Patients With Anterior Cruciate Ligament Reconstruction

Abstract

Background: Deciding when patients are ready to return to sport (RTS) after an anterior cruciate ligament (ACL) reconstruction (ACLR) is challenging. The understanding of which factors affect readiness and how they may be related is limited. Therefore, despite widespread use of RTS testing, there is a lack of knowledge about which tests are informative on the ability to resume sports. Purpose: To examine whether there is an association between knee laxity and psychological readiness to RTS after ACLR and to evaluate the predictive value of these measures on sports resumption. Study Design: Cohort study; Level of evidence, 2. Methods: Patients aged ≥16 years engaged in physical activity/sports before injury were recruited at routine clinical assessment 9-12 months after ACLR. Exclusion criteria were concomitant ligament surgery at ACLR and/or previous ACL injury in the contralateral knee. At baseline, a project-specific activity questionnaire and the ACL–Return to Sport After Injury (ACL-RSI) scale were completed. Knee laxity was assessed by use of the Lachman test, KT-1000 arthrometer, and pivot-shift test. Two years after surgery, knee reinjuries and RTS status (the project-specific questionnaire) were registered. Associations between psychological readiness and knee laxity were evaluated with the Spearman rho test, and predictive ability of the ACL-RSI and knee laxity tests were examined using regression analyses. Results: Of 171 patients screened for eligibility, 132 were included in the study. There were small but significant associations between the ACL-RSI score and the Lachman test (rho = −0.18; P = .046) and KT-1000 arthrometer measurement (rho = −0.18; P = .040) but no association between the ACL-RSI and the pivot-shift test at the time of recruitment. Of the total patients, 36% returned to preinjury sport level by 2 years after surgery. Higher age, better psychological readiness, and less anterior tibial displacement (KT-1000 arthrometer measurement) were significant predictors of 2-year RTS (explained variance, 33%). Conclusion: Small but significant associations were found between measurements of psychological readiness and anterior tibial displacement, indicating that patients with less knee laxity after ACLR feel more ready to RTS. ACL-RSI and KT-1000 arthrometer measurements were independent predictors of 2-year RTS and should be considered in RTS assessments after ACLR.

Predictors of Return to Activity at 2 Years After Anterior Cruciate Ligament Reconstruction Among Patients With High Preinjury Marx Activity Scores: A MOON Prospective Cohort Study

“…These authors similarly observed that a lower preinjury level of activity, in addition to female sex, lower education level, smoking status, higher BMI, use of an allograft, and revision ACLR, predicted lower activity scores at final followup. However, it is important to note the conspicuous difference in preinjury activity levels between the 3 aforementioned articles (median preinjury Marx activity score, 12 [IQR, [8][9][10][11][12][13][14][15][16]) and the current study (median preinjury Marx activity score, 16 [IQR, [12][13][14][15][16]). In the current study, .…”

“…28,29 Furthermore, the previous literature has shown that self-efficacy can be modified (ie, improved) by goal-setting and positive ''self-talk,'' which has been shown to enhance the yield of postoperative rehabilitation. 13 Resilience, defined generally as the capacity of a person to ''bounce back'' from an injury or insult, may be another related psychological parameter of interest for its effect on clinical outcomes. 24 It has been further suggested that patients' resilience may be modifiable through cognitive behavioral therapy modalities.…”

“…Patients most frequently reported a preinjury Marx activity score of 16 (n = 642 [54.0%]). The median preinjury Marx activity score was 16 (IQR, [12][13][14][15][16].…”

ACLD patients exhibit additional knee kinematic asymmetries at the speed level of healthy subjects

“…The increased anteroposterior ROM was due to the increased posterior translation during gait ( Figures 2B,C ). However, it was reported that the increment of anteroposterior ROM might risk the knee joint to reinjury ( Gupta et al, 2020 ; Yamasaki et al, 2021 ) and affect the readiness to return to sports ( Faleide et al, 2021 ). When walking at the speed level as healthy controls, the ACLD patients seemed to have close to “normal” (increased) knee flexion angles, especially the ROM of flexion angle ( Figure 2A ).…”

Multi-planar instability, laxity and reduced knee flexion during the support phase of walking are determinants of return to sports

“…Currently, the relationship between anterior knee stability and return-to-sports after ACL reconstruction is still being explored ( Keizer et al, 2021 ; Kamada et al, 2022 ). Faleide et al measured the anterior tibial translation of the knee joint with KT-1000 and found that it was one of the RTS factors ( Faleide et al, 2021 ). Some studies also found that the anterior stability of the knee joint after ACL reconstruction is closely related to the functional performance ( Andrä et al, 2021 ).…”