Fear of Reinjury Following Surgical and Nonsurgical Management of Anterior Cruciate Ligament Injury: An Exploratory Analysis of the NACOX Multicenter Longitudinal Cohort Study

Abstract

Objectives The purpose of this study was to compare fear and certainty of reinjury between follow-up time points and treatment groups (no anterior cruciate ligament [ACL] reconstruction [no ACLR], pre-ACLR, post-ACLR) and to identify prognostic factors for fear of reinjury at 3 and 12 months following injury or ACLR. Methods An exploratory analysis of the NACOX multicenter longitudinal cohort study was conducted. Patients (n = 275) with primary ACL injury and 15 to 40 years of age received usual care (initial physical therapist–supervised rehabilitation, before considering ACLR). Fear of reinjury (as measured with the Anterior Cruciate Ligament Quality of Life instrument [ACL-QOL] item 31 and the Anterior Cruciate Ligament Return to Sport After Injury instrument [ACL-RSI] item 9) and certainty of reinjury (as measured with the Knee Self-Efficacy Scale [K-SES] item D2) were evaluated at baseline and at 3-, 6-, and 12-months following ACL injury or ACLR. Comparisons were performed with linear mixed models. Linear regression assessed potential prognostic factors (age, sex, preinjury activity, baseline knee function, baseline general self-efficacy, and expected recovery time) for fear of reinjury (ACL-QOL item 31) at the 3- and 12-month follow-up assessments. Results Fear of reinjury was common regardless of ACL treatment. Fear of reinjury decreased between 3 and 6 months and 3 and 12 months (mean difference: ACL-QOL = 9 [95% CI = 2 to 15]; ACL-RSI = 21 [95% CI = 13 to 28]) after injury. This improvement was not observed in patients who later underwent ACLR, who reported worse fear of reinjury at 3 months (ACL-QOL = 10 [95% CI = 3 to 18]) and at 12 months (ACL-RSI = 22 [95% CI = 2 to 42]) postinjury compared with those who did not proceed to ACLR. Following ACLR, fear of reinjury decreased between the 3- and 12-month follow-up assessments (ACL-QOL = 10 [95% CI = 4 to 16]; ACL-RSI = 12 [95% CI = 5 to 19]). Greater baseline general self-efficacy was associated with reduced fear of reinjury at 12 months after injury (adjusted coefficient = 1.7 [95% CI = 0.0 to 3.5]). Female sex was related to more fear of reinjury 3 months after ACLR (−14.5 [95% CI = −25.9 to −3.1]), and better baseline knee function was related to reduced fear of reinjury 12 months after ACLR (0.3 [95% CI = 0.0 to 0.7]). Conclusions People who had ACLR reported worse fear of reinjury before surgery than those who did not proceed to ACLR. Different prognostic factors for fear of reinjury were identified in people treated with ACLR and those treated with rehabilitation alone. Impact Fear of reinjury is a concern following ACL injury. Clinicians should evaluate and address reinjury fears. These results may assist in identifying individuals at risk of fear of reinjury following surgical and nonsurgical management of ACL injury.

Fear of reinjury following primary anterior cruciate ligament reconstruction: a systematic review

“…Patients in earlier postoperative phases demonstrated greater kinesiophobia compared to patients in later recovery phases. One study reported decreases in kinesiophobia in their cohort of patients between the 3-and 12-month follow-up assessments following ACLR [17]. Results in this present review were consistent with their indings demonstrating that the degree of kinesiophobia was highest during the irst month (25.5 days) of rehabilitation and decreased signiicantly by the 7-month (224.9 days) mark.…”

“…It has been reported that men display greater self-eicacy and women tend to display greater anxiety towards rehabilitation and resuming activity following ACLR, and the degree of self-eicacy impacts kinesiophobia according to our results [44]. Additionally, women have been reported to show higher pain sensitivity, lower pain thresholds and greater fear and disability due to pain [17]. Further, patients with knee OA tend to have greater kinesiophobia following ACLR.…”

A Novel Predictor of the Length and Size of ACL Grafts in Chinese Han Adults for ACL Reconstruction: An MRI Study

“…9 ACL injury is most common in adolescents and may have negative long-term physical and psychological effects. [9][10][11][12][13] The treatment is intended to restore knee function, overcome psychological barriers against participation in activities, 13 prevent further injury and osteoarthritis, and optimize the long-term quality of life. Current treatment options for ACL injury mainly include surgery and conservative treatment, with ACL reconstruction (ACL-R) surgery being generally adopted for patients who have high requirements for motor function.…”

“…[17][18][19][20] Studies have shown that ACL-R helps inhibit tibial anterior translation, restore normal knee biomechanics, restore knee stability, prevent excessive torsion, relieve pain, restore function, return to sports activity, and reduce the incidence of complications. 5,13,[21][22][23][24] Given that the success rate of ACL-R is related to graft dimensions, [25][26][27] it is necessary to have an accurate assessment of the dimensions of the ACL-R graft preoperatively.…”

“…ACL injury is most common in adolescents and may have negative long‐term physical and psychological effects 9–13 . The treatment is intended to restore knee function, overcome psychological barriers against participation in activities, 13 prevent further injury and osteoarthritis, and optimize the long‐term quality of life.…”