Psychological Readiness and Injury-Related Fear are Associated with Persistent Knee Symptoms after ACL Reconstruction.

CONTEXT: Poor psychological responses after anterior cruciate ligament reconstruction (ACLR) have been associated with 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 (i.e., psychological readiness and injury-related fear) and the presence of persistent knee symptoms in individuals 6-12 months after ACLR.

DESIGN: Cross-Sectional.

SETTING: Research Laboratory.

PATIENTS OR OTHER PARTICIPANTS: One-hundred and two participants, ages 13-25 years old, between 6 and 12 months post primary, unilateral ACLR were enrolled in the study.

INTERVENTIONS(S): Persistent knee symptoms was identified using an established criterion based on the subscales of the Knee Injury and Osteoarthritis Outcome Score.

MAIN OUTCOME MEASURE(S): Participants also completed the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) and the Tampa Scale of Kinesiophhobia-11 (TSK-11) to assess psychological readiness and injury-related fear, respectfully. Higher ACL-RSI scores indicate higher psychological readiness and higher TSK-11 scores indicate higher injury-related fear.

RESULTS: Seventy participants (69%) met the criteria for persistent knee symptoms. For every standard deviation (SD) lower in ACL-RSI, a participants had 8.6 times greater odds of having persistent knee symptoms after ACLR (CI95: 3.3, 22.4). For every SD higher in TSK-11, a participants had 3.9 times greater odds of having persistent knee symptoms after ACLR (CI95: 2.1, 7.4). Both the ACL-RSI and TSK-11 were considered "good" at classifying persistent knee symptoms as areas under the curve were 0.88 and 0.83, respectfully.

CONCLUSIONS: Individuals with lower psychological readiness and higher injury-related fear after ACLR have greater odds of experiencing persistent knee symptoms. Overall, these results highlight the potential clinical benefit for a comprehensive, biopsychosocial approach to managing health and wellness for individuals after ACLR.