How Much Do Psychological Factors Affect Lack of Return to Play After Anterior Cruciate Ligament Reconstruction? A Systematic Review

Abstract

Background: Variables affecting return to sport after anterior cruciate ligament reconstruction (ACLR) are multifactorial. The nonphysical factors germane to successful return to play (RTP) are being increasingly recognized. Purpose: To (1) evaluate the available evidence base for psychological factors relating to RTP after ACLR, (2) identify psychological factors affecting RTP after ACLR, and (3) understand currently available metrics used to assess psychological RTP readiness. Study Design: Systematic review; Level of evidence, 4. Methods: A review of the MEDLINE database was performed for studies reporting RTP after ACLR. Studies reporting on the psychological determinants of RTP were included. Demographic, methodological, and psychometric properties of the included studies were extracted. Weighted analysis was performed after patients were pooled across included studies. Results: Of 999 studies identified in the initial search, 28 (2.8%) studies, comprising 2918 patients, were included; 19 studies (n = 2175 patients) reported RTP rates. The mean time for RTP was 17.2 months. There was a 63.4% rate of RTP, and 36.6% of patients returning to sport were not able to perform at their prior level of play. Of the 795 patients who did not achieve RTP, 514 (64.7%) cited a psychological reason for not returning. Fear of reinjury was the most common reason (n = 394; 76.7%); other psychological factors included lack of confidence in the treated knee (n = 76; 14.8%), depression (n = 29; 5.6%), and lack of interest/motivation (n = 13; 2.5%). The Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, the ACL–Return to Sport after Injury scale, and the Knee Self-Efficacy Scale were reported measures for assessing the influence of psychology on RTP. Conclusion: Psychological factors play an important role in RTP after ACLR. Among studies evaluating the impact of psychology on RTP, there was a delay in returning as well as lower RTP rates compared with the previously reported normative literature. Fear of reinjury was the most commonly reported impediment to RTP. The psychosocial measures identified in this review may have a role in RTP protocols for assessing mental resiliency; however, their roles need to be further investigated and validated in patients who have undergone ACLR.

Retorno Deportivo Luego de Reconstrucción Primaria de Ligamento Cruzado Anterior con Injerto Hueso-Tendón Patelar-Hueso Autólogo: Análisis de Factores Relacionados

“…46 Una revisión sistemática que incluyó 19 estudios y 2175 pacientes encontró que el 64,7% refirió factores psicológicos como determinantes de un retorno inferior al previo a la lesión; dentro de esos pacientes el 76,7% reportó temor a una nueva lesión. 47 Paterno, en un grupo de 40 pacientes encontró que los sujetos con temor significativo, evaluado a través de la "Tampa Scale of Kinesiophobia" tienen 13 veces más riesgo de volver a lesionarse dentro de 24 meses después de retornar al deporte. 3,48 Además del temor a una nueva lesión, distintos autores muestran factores como la falta de confianza, la inseguridad, la motivación y un cambio en las prioridades y en las expectativas como aspectos primordiales que explican la conducta postoperatoria ante la actividad deportiva.…”

Rates and Risk Factors of Revision Arthroscopy or Conversion to Total Knee Arthroplasty Within 1 Year Following Isolated Meniscectomy

“…With respect to anterior cruciate ligament reconstruction, psychological factors lead to a decreased rate of return to sport and an increased length of time until return to sport. 34 The most commonly cited reason for the inability to return to sport is the fear of reinjury. 34 Similarly, patients with depression and other psychological disorders may be fearful of returning to previous activities, and they experience lower functional improvement following arthroscopic meniscectomy.…”

“… 34 The most commonly cited reason for the inability to return to sport is the fear of reinjury. 34 Similarly, patients with depression and other psychological disorders may be fearful of returning to previous activities, and they experience lower functional improvement following arthroscopic meniscectomy. In turn, this may lead to a higher risk of revision arthroscopy or conversion to TKA due to continued symptomatology and pain.…”

Injury Prevention in Youth Football Players : Training Effects and Programme Implementation

“…When looking at the whole injury panorama, most time-loss injuries in youth result in absence from football play of less than one week, whereas only 10-15% are defined as severe, with an absence of more than 28 days 33 . There is a risk of recurrent injuries 17 and players may avoid or delay return to sport due to fear of re-injury 121 .…”

“…Overuse injuries, due to frequent loading, are also seen in youths participating in sports 23 . Sports injuries may lead to absence from sport 157 , heightened risk of reinjury 83 and fear of re-injury 121 . Hence, there is good reason to try and prevent these injuries.…”