Patient Outcomes Following Anterior Cruciate Ligament Reconstruction: The Influence of Psychological Factors

Brand, Emily; Nyland, John

doi:10.3928/01477447-20090502-01

Cited by 49 publications

(47 citation statements)

References 26 publications

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“…7 Taken together, the results of the current study and of previous research suggest that other aspects of recovery, such as psychological factors, are also important for returning to sport and may have been underrecognized. 14,32 This study found that factors influencing athletes' prospective judgment of their ability to return to sport predicted returning to the preinjury level. This judgment involved the athlete taking into account his or her psychological readiness to return, his or her perception of control over the return, and a timeline for return, which supports the notion that individuals are more likely to engage in an activity when they perceive greater competence and therefore have higher self-efficacy in the particular activity.…”

Section: Discussionmentioning

confidence: 93%

Psychological Responses Matter in Returning to Preinjury Level of Sport After Anterior Cruciate Ligament Reconstruction Surgery

et al. 2013

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Psychological responses before surgery and in early recovery were associated with returning to preinjury level of sport at 12 months, suggesting that attention to psychological recovery in addition to physical recovery after ACL injury and reconstruction surgery may be warranted. Clinical screening for maladaptive psychological responses in athletes before and soon after surgery may help clinicians identify athletes at risk of not returning to their preinjury level of sport by 12 months.

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Section: Discussionmentioning

confidence: 93%

Psychological Responses Matter in Returning to Preinjury Level of Sport After Anterior Cruciate Ligament Reconstruction Surgery

et al. 2013

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“…13,31,33,[37][38][39] People with higher self-efficacy levels have more positive outcomes after rehabilitation because they have confidence in their ability to complete the tasks that are presented to them; this may, in turn, facilitate greater adherence to rehabilitation. 13,38,39 Rehabilitation programs that incorporate techniques such as positive selftalk and goal setting have been associated with increased adherence to home rehabilitation and greater perceived effort.…”

Section: Discussionmentioning

confidence: 99%

Decision to Return to Sport After Anterior Cruciate Ligament Reconstruction, Part I: A Qualitative Investigation of Psychosocial Factors

Burland

Toonstra

Werner

et al. 2018

Journal of Athletic Training

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Context: Return-to-sport criteria after anterior cruciate ligament (ACL) injury are often based on “satisfactory” functional and patient-reported outcomes. However, an individual's decision to return to sport is likely multifactorial; psychological and physical readiness to return may not be synonymous. Objective: To determine the psychosocial factors that influence the decision to return to sport in athletes 1 year post–ACL reconstruction (ACLR). Design: Qualitative study. Setting: Academic medical center. Patients or Other Participants: Twelve participants (6 males, 6 females) were purposefully chosen from a large cohort. Participants were a minimum of 1-year postsurgery and had been active in competitive athletics preinjury. Data Collection and Analysis: Data were collected via semistructured interviews. Qualitative analysis using a descriptive phenomenologic process, horizontalization, was used to derive categories and themes that represented the data. The dynamic-biopsychosocial model was used as a theoretical framework to guide this study. Results: Six predominant themes emerged that described the participants' experiences after ACLR: (1) hesitation and lack of confidence led to self-limiting tendencies, (2) awareness was heightened after ACLR, (3) expectations and assumptions about the recovery process influenced the decision to return to sport after ACLR, (4) coming to terms with ACL injury led to a reprioritization, (5) athletic participation helped reinforce intrinsic personal characteristics, and (6) having a strong support system both in and out of rehabilitation was a key factor in building a patient's confidence. We placed themes into components of the dynamic-biopsychosocial model to better understand how they influenced the return to sport. Conclusions: After ACLR, the decision to return to sport was largely influenced by psychosocial factors. Factors including hesitancy, lack of confidence, and fear of reinjury are directly related to knee function and have the potential to be addressed in the rehabilitation setting. Other factors, such as changes in priorities or expectations, may be independent of physical function but remain relevant to the patient-clinician relationship and should be considered during postoperative rehabilitation.

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“…Despite this, the focus of the orthopaedic literature has been on evaluating impairment-based outcomes, such as knee stability, after reconstruction as a measure of the success of the surgery, while non-physical factors, including psychological factors, have been under-researched 1 2. From an impairment perspective, patients recover physical function well after surgery 3.…”

Section: Introductionmentioning

confidence: 99%

The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction

et al. 2014

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Background This cross-sectional study aimed to examine whether appraisal of knee function, psychological and demographic factors were related to returning to the preinjury sport and recreational activity following anterior cruciate ligament (ACL) reconstruction. Method 164 participants completed a questionnaire battery at 1-7 years after primary ACL reconstruction. The battery included questionnaires evaluating knee self-efficacy, health locus of control, psychological readiness to return to sport and recreational activity, and fear of reinjury; and self-reported knee function in sport-specific tasks, knee-related quality of life and satisfaction with knee function. The primary outcome was returning to the preinjury sport or recreational activity. Results At follow-up, 40% (66/164) had returned to their preinjury activity. Those who returned had more positive psychological responses, reported better knee function in sport and recreational activities, perceived a higher knee-related quality of life and were more satisfied with their current knee function. The main reasons for not returning were not trusting the knee (28%), fear of a new injury (24%) and poor knee function (22%). Psychological readiness to return to sport and recreational activity, measured with the ACL-Return to Sport after Injury scale (was most strongly associated with returning to the preinjury activity). Age, sex and preinjury activity level were not related. Conclusions Less than 50% returned to their preinjury sport or recreational activity after ACL reconstruction. Psychological readiness to return to sport and recreation was the factor most strongly associated with returning to the preinjury activity. Including interventions aimed at improving this in postoperative rehabilitation programmes could be warranted to improve the rate of return to sport and recreational activities

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Patient Outcomes Following Anterior Cruciate Ligament Reconstruction: The Influence of Psychological Factors

Abstract: Despite reports demonstrating good-to-excellent results, only 65% to 70% of patients return to their preinjury level of sports activity following anterior cruciate ligament reconstruction. Psychological factors may contribute to this performance disparity.

Cited by 49 publications

References 26 publications

Psychological Responses Matter in Returning to Preinjury Level of Sport After Anterior Cruciate Ligament Reconstruction Surgery

Psychological Responses Matter in Returning to Preinjury Level of Sport After Anterior Cruciate Ligament Reconstruction Surgery

Decision to Return to Sport After Anterior Cruciate Ligament Reconstruction, Part I: A Qualitative Investigation of Psychosocial Factors

The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction

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