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Updated: Jun 25, 2026
Early Weight-Bearing Rehabilitation Protocol After Anterior Cruciate Ligament Reconstruction
Published on: March 1, 2024
Prehabilitation for Patients Undergoing Anterior Cruciate Ligament Reconstruction Reduces Kinesiophobia Levels at
Sean Wei Loong Ho1,2, Ming Foo Kenneth Nah1, Oliver Tze Rong Lim2
1Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore.
Background:
Anterior cruciate ligament (ACL) injuries are the most common knee ligament injuries and ACL reconstruction (ACLR) is often required to restore stability and facilitate return-to-sport. However, kinesiophobia-fear of movement due to risk of reinjury-is prevalent post-ACLR (62% to 78%) and linked to poor return-to-sport outcomes despite good physical recovery.
Hypothesis:
Patient, injury, surgery, and rehabilitation factors can be associated with elevated kinesiophobia in patients undergoing primary ACLR.
Study Design:
Retrospective cohort study.
Level Of Evidence:
Level 3.
Methods:
A retrospective review was conducted using data from a tertiary acute hospital's ACL registry between June 1, 2019 and June 1, 2023. Included were patients aged 18 years to 60 years undergoing primary ACLR. Exclusions were revision ACLR, multiligament injuries, and incomplete 1-year dataset. Demographics, injury/surgery/rehabilitation factors and patient-reported outcomes were measured preoperatively, and at 6 months and 1 year. Tampa Scale of Kinesiophobia-17 (TSK-17, with ≥37 indicating elevated kinesiophobia), was recorded preoperatively and 1 year postoperatively. Multivariate regression was used to identify predictors of elevated 1-year kinesiophobia.
Results:
Data from 200 patients were analyzed (8 excluded due to incomplete data). Baseline TSK-17 was 38.6 ± 5.6, improving to 32.6 ± 7.6 at 1 year (P < 0.001), with 59% showing elevated kinesiophobia at baseline and 29% at 1 year. The average TSK-17 reduction was 6.1 ± 8.6, meeting the minimal clinically important difference (MCID) level. Prehabilitation was attended by 106 patients (55.21%), with a median of 1 session (range 0-10). Elevated 1-year kinesiophobia was associated significantly with higher baseline TSK-17 scores (odds ratio [OR], 2.004; 95% CI, 1.013-3.968; P = 0.05) and inversely associated with attending ≥1 prehabilitation session (OR, 0.513; 95% CI, 0.264-0.997; P = 0.05).
Conclusion:
Prehabilitation before ACLR should be standard-of-care, to reduce risk of elevated kinesiophobia at 1-year.
Clinical Relevance:
High baseline kinesiophobia predicts sustained elevated 1-year kinesiophobia, hence assessment (TSK-17 scores) and early intervention targeting kinesiophobia should be included in preoperative ACLR protocols.