Psychological Readiness, Injury-Related Fear, and Persistent Knee Symptoms After Anterior Cruciate Ligament
Shelby Baez1, Matthew Harkey2, Thomas Birchmeier1
1Department of Exercise and Sport Science, University of North Carolina at Chapel Hill.
Context:
Poor psychological responses after anterior cruciate ligament reconstruction (ACLR) have been associated with a failure to return to sport and increased secondary injury risk. However, we do not know whether poor psychological responses after ACLR influence patient-reported knee function and knee symptoms.
Objective:
To examine the association between psychological factors (ie, psychological readiness and injury-related fear) and the presence of persistent knee symptoms in individuals 6 to 12 months after ACLR.
Design:
Cross-sectional study.
Setting:
Research laboratory.
Patients Or Other Participants:
In total, 101 participants, aged 13 to 25 years old, between 6 and 12 months after primary unilateral ACLR were enrolled in the study.
Main Outcome Measure(S):
Persistent knee symptoms were identified using an established criterion based on the subscales of the Knee injury and Osteoarthritis Outcome Score. Participants also completed the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) and the Tampa Scale of Kinesiophobia-11 (TSK-11) to assess psychological readiness and injury-related fear, respectively. Higher ACL-RSI scores indicate higher psychological readiness, and higher TSK-11 scores indicate higher injury-related fear.
Results:
Twenty-nine participants (29%) met the criteria for persistent knee symptoms. For every 1 SD lower in the ACL-RSI score, participants had 2.1 times greater odds of persistent knee symptoms after ACLR (95% CI = 1.3, 3.6). For every 1 SD higher in the TSK-11 score, participants had 1.9 times greater odds of persistent knee symptoms after ACLR (95% CI = 1.1, 3.3). Both the ACL-RSI and TSK-11 were considered good at classifying persistent knee symptoms, as the areas under the curve were 0.78 and 0.73, respectively.
Conclusions:
Individuals with a lower level of psychological readiness and more injury-related fear after ACLR had greater odds of persistent knee symptoms. Overall, these results highlight the potential clinical benefit of a comprehensive, biopsychosocial approach to managing health and wellness for individuals after ACLR.
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