Psychological factors are associated with return to pre-injury levels of sport and physical activity after ACL reconstruction

Abstract

Purpose The impetus of anterior cruciate ligament reconstruction (ACLR) is to allow patients to return to sport and to remain engaged in physical activity. Many patients exhibit deficits in psychological domains of health‐related quality of life which may impede return to sport and physical activity participation. Therefore, the purpose of this study was to examine the association of patient‐based, specifically psychological, and functional outcomes with return to sport and physical activity. Methods Forty participants, a minimum of 1‐year post‐ACLR, reported to the laboratory for one‐testing session. Participants completed a series of patient‐based and functional outcome assessments. Participants were also instructed to wear a pedometer for 1 week to monitor their daily steps. Results Twenty‐five participants (62%) did not return to sport and 29 participants (72%) did not average 10,000 steps per day. Individuals with elevated levels of self‐reported kinesiophobia were 17% less likely to return to sport. Self‐reported knee self‐efficacy and knee‐related quality of life accounted for 27.1% of the variance of average daily step counts. Conclusions Psychological factors, specifically injury‐related fear and self‐efficacy, were associated more significantly than functional outcomes with return to sport and physical activity levels. Clinicians should examine psychological factors throughout rehabilitation in patients after ACLR. Future research should explore the effectiveness of psychoeducation techniques to decrease injury‐related fear and enhance self‐efficacy in this population. Level of evidence III.

Assessment of Free-Living Cadence Using ActiGraph Accelerometers Between Individuals With and Without Anterior Cruciate Ligament Reconstruction

“…26 Whereas not a direct measure of physical activity intensity among individuals with ACLR, daily step count is a clinically feasible measure that is strongly related to time engaged in moderate to vigorous physical activity in this population. 7 In our study, the ACLR group took fewer steps per day than did the control group (8422 6 2663 steps per day versus 10 033 6 3046 steps per day), and the differences in step counts were similar to those described by Bell et al 7 (8158 6 2780 steps per day versus 9769 6 2785 steps per day) and Baez et al 28 (7754 6 2399 steps per day versus 9199 6 2385 steps per day) among similar populations. We are the first to identify that, in addition to diminished daily step counts, the ACLR group also displayed less average minute-level cadence at high step rates than the control group (Figure).…”

Early Return to Sports to Continue the Season after Anterior Cruciate Ligament Injury Is Not Recommended for Student Athletes

“…Baez et al reported that injury-related fear was associated with RTS and physical activity levels after ACLR. 22 ) Hartigan et al reported that kinesiophobia before surgery was lower in potential copers than in non-copers, but kinesiophobia before surgery was higher than that after surgery in both groups. 23 ) Although we did not investigate psychological factors, psychological evaluations should be conducted in future studies.…”

Advanced training enhances readiness to return to sport after anterior cruciate ligament reconstruction

“…Previous research has shown that the level of kinesiophobia is higher and level of knee activity selfefficacy is lower in patients that do not return to sport following ACL reconstruction. 18,[32][33][34] In addition, the intensity of fear is highest for activities and situations that are specific to each patient. 26 Kinesiophobia, or pain-related fear of movement/reinjury, was assessed with the 11-item Tampa Scale for Kinesiophobia (TSK-11).…”