Injury-Related Fears During the Return-to-Sport Phase of ACL Reconstruction Rehabilitation

Abstract

Background: Fear of reinjury is common after anterior cruciate ligament reconstruction (ACLR) and often deters a return to preinjury sport participation. A better understanding of injury-related fear is needed to inform rehabilitation strategies. Purpose/Hypothesis: The purpose of this study was to (1) identify individual fear-evoking tasks or situations, (2) compare the intensity and amount of change relative to other injury-related fears (reinjury, knee giving way, and knee pain) after completion of a return-to-sport training program, and (3) determine whether standardized questionnaires can identify the intensity of fear for the individual fear-evoking task or situation and for fear of reinjury. The hypothesis was that the task or situation that evokes fear would vary across patients and the intensity of that fear would be higher and show less change after return-to-sport training compared with other injury-related fears. Study Design: Case series; Level of evidence, 4. Methods: Participants included 33 patients (15 males; mean age, 18 years) with ACLR who enrolled in a group-format return-to-sport training program. Questionnaires completed before and after return-to-sport training included items to specify fear-evoking tasks or situations, items to rate the intensity of various injury-related fears, the Anterior Cruciate Ligament Return to Sport after Injury scale (ACL-RSI), and the Tampa Scale for Kinesiophobia (TSK-11). Results: The most common fear-evoking task or situation was cutting, followed by contact, jumping, and other. Intensity of fear-evoking task or situation was higher than other injury-related fears, but all fears decreased in intensity after training. The ACL-RSI score better identified the intensity of fear for the individual fear-evoking task or situation and for fear of reinjury than did the TSK-11 score. Conclusion: Activities that evoke fear vary across patients, but fear of cutting is common. The intensity of common fears after ACLR decreased after advanced group training, and large effect sizes were seen for nearly all examined fears. Fear of reinjury and intensity of individually feared tasks may be better reflected in the ACL-RSI score than the TSK-11 score.

The Design of a Track Monitoring System for Sports Injury Rehabilitation Training

“…The more active the patients are to participate, the better the training effect will be. Rehabilitation training should maximize the number of repetitions of training and maximize the active efforts of patients, which is one of the most widely accepted principles in the field of rehabilitation clinical and rehabilitation engineering [ 8 ]. However, in the robot-assisted rehabilitation training, the robot mainly adopts an adaptive control algorithm to assist the patient, which allows the patient to reduce their active efforts, which leads to the patient slackening, inertia, and reduced rehabilitation effect.…”

Advanced training enhances readiness to return to sport after anterior cruciate ligament reconstruction

“…This agrees with findings of no change in TSK-11 scores after plyometric training administered at an earlier timeframe post ACLR, 24 and persistent injury-related fears after advanced training. 26 Further research is needed to determine alternative ACLR rehabilitation approaches to address injury-related fear. It is possible that graded exposure treatment approach, which identifies and hierarchically exposes patients to their specific fear, might be needed to address injury-related fear as it has shown benefit for other fears and phobias.…”

“…[20][21][22] These programs usually target the 6-12 months postoperative time period and generally include lower extremity strengthening and neuromuscular training (agility, perturbations and/or plyometrics) at an increased intensity level compared to standard rehabilitation. 16,23 Research has shown that potential benefits of advanced training include improved function, [22][23][24] improved passing rate on return to sport criteria consisting of physical impairment and psychological measures, 16 and possibly prevention of secondary (re)-injury 22,25 Even without an explicit psychological intervention, previous studies have shown that patients who complete advanced training have improved overall psychological readiness for sport participation 26 and improved selfefficacy for knee-related activities. 24 To our knowledge, no study has directly compared physical and psychological outcomes in patients that did or did not participate in advanced training during the return to sport phase following ACLR.…”

Evaluation of the Responsiveness of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale

“…36 From a psychological perspective, the return-to-sport phase after ACL reconstruction surgery has been shown to be particularly challenging for some athletes, as negative emotions can be heightened at this time and can even lead to an avoidance of return to play. 3,24 It has been estimated that up to half of athletes do not return to competitive sport after ACL reconstruction surgery. 2 Published in 2008, the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale was developed as a tool to evaluate psychological readiness to return to sport after ACL injury, and it is currently the only scale specific to ACL injury.…”