Psychosocial factors 3‐months after anterior cruciate ligament reconstruction predict 6‐month subjective and objective knee outcomes

Abstract

The objective of the study was to determine if psychological readiness for sport and knee self-efficacy assessed early (3 months) after anterior cruciate ligament reconstruction (ACLR) are predictive of self-reported functional outcomes, quadriceps strength, and knee mechanics while running at the time of return to sport training (6 months). Thirty athletes with unilateral ACLR completed the ACL Return to Sport after Injury (ACL-RSI) and Knee Self-Efficacy Scale (K-SES) 3 months after ACLR and completed self-reported functional outcomes, isometric quadriceps strength testing, and three-dimensional running gait analysis 6 months after ACLR. The 3-month ACL-RSI significantly correlated with the 6-month International Knee Documentation Committee (IKDC; r = 0.565, p = 0.001), Knee Injury and Osteoarthritis Outcome Score (KOOS) sport/recreational activities (KOOS Sport ; r = 0.548, p = 0.002) and quality of life (KOOS QoL ; r = 0.431, p = 0.017), and quadriceps strength (r = 0.528, p = 0.003). The 3-month K-SES significantly correlated with the 6-month IKDC (r = 0.528, p = 0.003), KOOS Sport (r = 0.430, p = 0.018), KOOS QoL (r = 0.411, p = 0.024), quadriceps strength (r = 0.465, p = 0.010), and knee flexion excursion (r = 0.472, p = 0.008). With multivariate modeling, both the ACL-RSI and K-SES were predictive of the IKDC (R 2 = 0.411; p = 0.001). Only the ACL-RSI was predictive of the KOOS Sport (R 2 = 0.300; p = 0.002), KOOS QoL (R 2 = 0.186; p = 0.017), and quadriceps strength (R 2 = 0.279; p = 0.003), whereas only the K-SES was predictive of knee flexion excursion (R 2 = 0.173; p = 0.022). Athletes with greater psychological readiness for sport and knee self-efficacy at 3 months demonstrated higher scores on self-reported functional outcomes, greater quadriceps strength, and greater knee flexion excursion at 6 months after ACLR. This study indicates that psychosocial measures may be important to include into early post-surgical evaluations to help guide and facilitate interventions to restore subjective and objective knee function.

The Influence of Psychosocial Factors on Patients Undergoing Anterior Cruciate Ligament Reconstruction

“…33,51 Chmielewski and George 9 concluded that psychosocial correlates that predict outcomes - such as the subfactors as well as larger themes of kinesiophobia, self-efficacy, and pain catastrophizing - can be detected as early as 4 weeks after ACLR. Erickson et al 12 observed correlates of psychosocial measures at 3 months post-ACLR to predict 6-month outcomes. Both suggested that earlier detection creates opportunities to intervene and improve outcomes.…”

“…Further investigation is needed to identify the optimal timeframe for psychosocial testing, but current consensus supports earlier testing. 12 Earlier detection may help clinicians implement interventions; however, evidence-based research is still needed to determine standardized interventions. Ultimately, the inconsistencies and failure to evaluate the psychosocial profile of patients may impact outcomes negatively after ACLR.…”

“…In patients who RTS, psychological readiness has been correlated positively with individual test performances across multiple studies; these tests include quadriceps strength, hamstring strength, symmetrical muscle function, and frontal plane knee and hip range of motion during single-leg biomechanics. 5,12,17,45,61,63 Similarly, Sugarman et al 62 evaluated functional performance and psychological readiness in patients who had undergone ACLR utilizing the ACL-RSI. Those scoring higher on ACL-RSI performed significantly better on isometric knee flexion.…”

Can a Psychologic Profile Predict Successful Return to Full Duty After a Musculoskeletal Injury?

“…Because injuries are bound to happen in this physically active population, tactics to promote successful recovery and prevent subsequent injuries are needed to save time and resources spent on rehabilitation. Many studies have examined the associations of psychologic variables and return to physical activity with the risk of reinjury in the context of sports injuries [7,12,19,27,32,44]. Such findings are encouraging, because soldiers are tactical athletes who experience injuries because of physical activity similar to that of civilian athletes.…”

“…Unlike previously identified injury risk factors such as age [8,18,33,47], gender [4,38], and prior injury [9,44,51], which are nonmodifiable [39], psychologic variables have been known to fluctuate across different stages of the health injury continuum [48], similar to physical function, and could be future targets of intervention to aid in successful return to full duty. There is no universal consensus on the defintion of "psychologic readiness" to return to sports [32]; however, relationships between several different psychologic constructs and return to sport [27], future injury [44], rehabilitation adherence [12], and functional outcomes [7] after injuries have been reported. For instance, fear of reinjury has been associated with poor rehabilitation outcomes, difficulties with returning to sport, or even with function and distraction when returning to sport [19].…”