Association Between Functional Muscle Assessment and Psychological Factors on Return to Sport and Graft Failure After...

Few researchers have examined both psychological and physical factors simultaneously in return to sport (RTS) and reinjury.

To assess the role of psychological profiles and physical aspects in RTS and reinjury risk and to inform and develop innovative treatment strategies that may be beneficial after anterior cruciate ligament (ACL) reconstruction.

Cohort study; Level of evidence, 2.

During the rehabilitation process, patients (aged 18-45 years) with ACL reconstruction (using patellar tendon or hamstring autografts) were screened. A statistical analysis was conducted using the cluster method and ascending hierarchical cluster analysis (Ward method), which allowed us to highlight a 4-cluster solution (P < .001). Muscle strength (maximal isokinetic strength of the quadriceps/hamstring, single-leg hop test between 3 and 6 months) and psychological factors were measured. A follow-up call was made to patients in the second year after surgery.

The study included a total of 162 athletes to determine psychological profiles. The prospective follow-up percentage for patients who responded was 75.9% regarding RTS and reinjury. Profile 1 (intermediate) was characterized by "moderate reinjury anxiety, no depression"; profile 2 (intermediate depressive) by "moderate reinjury anxiety and minor anxious-depressive reaction"; profile 3 (confident) by "no reinjury anxiety, no depression, high confidence"; and profile 4 (negative) by "high anxiety, high depression, low confidence." The percentage of female athletes was higher in profile 4 than in profile 3 (P < .01). Profile 4 had the lowest RTS rate with 45.8% (profile 3: 77.8%; P = .01). Profile 3 had the least strength deficit (muscular quadriceps force at 90 and 240 deg/sec between profile 3 versus 1 (P = .01; P = .02), 3 versus 4 (P = .001; P = .004), and hamstring profile 3 versus 2 (P = .006). Profile 3 was associated with difference in timing to RTS between profile 3 versus 1 (P = .0004), 3 versus 4 (P = .007), and 3 versus 2 (P = .002). Profile 3, with a more quickly achieved RTS (mean = 222 days), had a higher reinjury rate at 13.9% (compared with profile 4: 0%; P = .047). Profile 3 reported all 5 cases of reinjury before return to competition. Profiles 1 and 2 with reinjuries (P = .003) suffered a strength deficit (12.9%-22.9%), primarily in the hamstrings (P = .049).

Profile 3, which was the most confident and least deficient, and recovered the fastest, had the most relapses. Reinjured athletes in profiles 1 and 2 had deficits in strength, particularly in their hamstrings. Individuals in profile 4, who rarely returned to sports, were the most anxious, the most deficient, and had the greatest difficulty returning to sports.