Sex-Specific Differences in Psychological Response to Injury and Return to Sport Following ACL Reconstruction

Abstract

* Recent literature has focused on the psychological aspects associated with recovery that may affect outcomes following anterior cruciate ligament (ACL) reconstruction.* Psychological factors such as self-efficacy, locus of control, athletic identity, and fear of reinjury have been shown to impact the recovery and rehabilitation process.* Men and women display different psychological responses to injury; men report greater self-efficacy postoperatively and a loss of overall self-worth with injury, whereas women are self-directed and exhibit greater anxiety concerning an injury’s impact on their lives and a loss of physical self-worth with injury.* Preoperative identification of sex-specific psychological factors that are known to affect return to sport following ACL reconstruction may contribute to improved return to sport and quality of life.

A Comparison of Psychological Readiness and Patient-Reported Function Between Sexes After Anterior Cruciate Ligament Reconstruction

“…Although the literature in this area is still developing, men have tended to display greater selfefficacy after surgery, whereas women described greater anxiety related to recovery and return to activity after ACLR. 13 We hypothesized that these variations would ultimately result in clinically meaningful differences in fear of movement and readiness for return to sport during the terminal phases of rehabilitation; however, our results did not support these hypotheses. Patients who fail to meet clinically important cutoff scores on the ACL-RSI or TSK-11 scales during rehabilitation may reflect a variety of psychological barriers that may or may not be informed by their sex, gender identification, or other factors (eg, strength, jumping performance, movement biomechanics) that we did not examine in this study.…”

“…11,12 In support of these assessments, improved psychological readiness for return to sport and reduced fear of movement, assessed 4 to 6 months after ACLR via the ACL Return to Sport after Injury (ACL-RSI) scale and Tampa Scale of Kinesiophobia (TSK-11), respectively, have been linked to successful return to preinjury levels of sport at 1 year and a reduced risk of subsequent ACL injury at 2 years after ACLR among young and active individuals. 11,12 However, according to the authors of a recent review, 13 the psychological response to ACLR may not be consistent between the sexes. Female patients tended to describe greater psychological distress and lesser selfefficacy that male patients at similar time points after ACLR.…”

“…Female patients tended to describe greater psychological distress and lesser selfefficacy that male patients at similar time points after ACLR. 13 Whereas the ACL-RSI scale and TSK-11 are commonly used to assess psychological readiness for return to sport among individuals with ACLR, little is known about the influence of patient sex on these outcome measures. This factor is especially important given the previously described sex-based disparities in functional outcomes, 10 rates of return to sport, 5 and rates of reinjury, 2 all of which have been linked to psychological outcomes among this clinical population.…”

The Influence, Barriers to and Facilitators of Anterior Cruciate Ligament Rehabilitation Adherence and Participation: a Scoping Review

“…The most to least commonly reported psychological variables were self-motivation [13,21,58,59,65,68,69], athletic identity [13,58,59,65,68,69], self-efficacy [58,60,[65][66][67][68], self-confidence [13,60,65,68,69], positive self-talk [58-60, 65, 68], social support [13,59,60,65,68], optimism [13,65,68,69], goal setting [59,60,65,68], stress [13,21,58,65], fear of reinjury [58,66,68], locus of control [59,69], age and sex differences in psychology [60,69], self-esteem…”

“…The most to least commonly reported psychological variables were self-motivation [ 13 , 21 , 58 , 59 , 65 , 68 , 69 ], athletic identity [ 13 , 58 , 59 , 65 , 68 , 69 ], self-efficacy [ 58 , 60 , 65 – 68 ], self-confidence [ 13 , 60 , 65 , 68 , 69 ], positive self-talk [ 58 – 60 , 65 , 68 ], social support [ 13 , 59 , 60 , 65 , 68 ], optimism [ 13 , 65 , 68 , 69 ], goal setting [ 59 , 60 , 65 , 68 ], stress [ 13 , 21 , 58 , 65 ], fear of reinjury [ 58 , 66 , 68 ], locus of control [ 59 , 69 ], age and sex differences in psychology [ 60 , 69 ], self-esteem [ 58 ], pain tolerance [ 58 ], mood disturbance [ 58 ], situational stability [ 59 ], cognitive appraisal [ 66 ] and coping strategies [ 60 ], previous experiences [ 66 ] and attitudes [ 66 ]. As most of the reviews are narrative in nature and with a low overall evidence base (8 original studies), most of the conclusions within each review are theoretical in nature and were drawn from a wider evidence base from other injuries and disciplines.…”