Kinesiophobia Associates With Physical Performance in Patients With ACL Reconstruction: A Critically Appraised Topic

Anterior cruciate ligament (ACL) injuries remain one of the most common and debilitating injuries that physically active individuals experience. Pain-related fear of movement and/or reinjury, or kinesiophobia, is the most frequently cited reason for not returning to sport after ACL reconstruction. Understanding how kinesiophobia may impact recovery of physical performance is essential to guide targeted rehabilitation.

Does kinesiophobia associate with physical performance in patients with a history of ACL reconstruction?

Five cross-sectional studies investigating bivariate relationships between kinesiophobia and metrics of physical performance among individuals with a history of primary, unilateral ACL reconstruction were included. From a strength perspective, greater kinesiophobia associated with lesser isometric knee flexion torque (n = 1, negligible association) but did not associate with isokinetic or isometric knee extension torque (n = 2). In terms of functional movement, greater kinesiophobia associated with asymmetric single-leg step-down performance (n = 1, high association) and shorter single-leg hop distance (n = 1, negligible association). Biomechanically, greater kinesiophobia associated with worse drop jump landing, characterized by greater frontal plane motion and lesser sagittal plane motion at the hip and knee joints (n = 1, low to high association).

Very low-quality evidence suggests a muscle-specific association between kinesiophobia and strength. Low- to moderate-quality evidence suggests that greater kinesiophobia associates with worse functional movement and landing biomechanics.

Considering the consistency and level of evidence among the included studies, we offer the following grades for each construct of physical performance evaluated: strength, D; functional movement, B; and biomechanics, B.