Kinesiophobia following ACL reconstruction: a qualitative netnographic study of lived experiences shared on Reddit

Kinesiophobia, broadly defined as fear of movement and vulnerability to (re)injury, is one of the most significant psychological barriers to functional recovery following anterior cruciate ligament (ACL) reconstruction, yet its everyday, lived texture is not fully captured by structured psychometric instruments. Orthopedic clinicians frequently observe that patients who have achieved objective surgical and functional recovery nonetheless remain reluctant to resume movement. This study aimed to explore this phenomenon in patients' own words.

We conducted a qualitative netnographic study of 50 first-person Reddit narratives shared by individuals with ACL injury, spanning the rehabilitation trajectory from preoperative anxiety to chronic post-return instability. Data were analyzed using Braun and Clarke's reflexive thematic analysis by an interdisciplinary team of orthopedic surgeons and psychiatrists.

Three interconnected themes emerged. First, a progressive loss of trust in the injured body, in which normal postoperative sensations were hypervigilantly monitored and catastrophically reinterpreted as signs of graft failure, persisting even after objective strength testing and medical clearance. Second, fear-driven disruption of functional identity and future planning, in which reinjury fear extended beyond the knee to threaten occupational continuity, financial security, and physical self-concept. Third, persistent uncertainty and compulsive reassurance-seeking, fueled by inconsistent rehabilitation guidance and unfavorable social comparison with peers' recovery timelines on social media.

Psychological readiness for return to activity appears to be shaped by an interacting network of bodily, identity-related, and informational factors that extend beyond fear of reinjury as traditionally measured. Incorporating expectation management, structured reassurance, and psychologically informed communication into postoperative care protocols may benefit orthopedic and rehabilitation teams. Naturally occurring online narratives may serve as an ecologically valid source of insight into the psychological dimensions of ACL recovery, complementing structured psychometric assessment.