Psychological and Social Components of Recovery Following Anterior Cruciate Ligament Reconstruction in Young Athletes: A Narrative Review

Abstract

Anterior cruciate ligament (ACL) rupture is a common injury in young athletes. To restore knee stability and function, patients often undergo ACL reconstruction (ACLR). Historically, there has been a focus in this population on the epidemiology of ACL injury, the technical aspects of ACL reconstruction, and post-operative functional outcomes. Although increasingly recognized as an important aspect in recovery, there remains limited literature examining the psychological aspects of post-operative rehabilitation and return to play following youth ACL reconstruction. Despite technical surgical successes and well-designed rehabilitation programs, many athletes never reach their preinjury athletic performance level and some may never return to their primary sport. This suggests that other factors may influence recovery, and indeed this has been documented in the adult literature. In addition to restoration of functional strength and stability, psychological and social factors play an important role in the recovery and overall outcome of ACL injuries in the pediatric population. Factors such as psychological readiness to return-to-play (RTP), motivation, mood disturbance, locus of control, recovery expectations, fear of reinjury, and self-esteem are correlated to the RTP potential of the young athlete. A better understanding of these concepts may help to maximize young patients’ outcomes after ACL reconstruction. The purpose of this article is to perform a narrative review of the current literature addressing psychosocial factors associated with recovery after ACL injury and subsequent reconstruction in young athletes. Our goal is to provide a resource for clinicians treating youth ACL injuries to help identify patients with maladaptive psychological responses after injury and encourage a multidisciplinary approach when treating young athletes with an ACL rupture.

Patient-Reported Outcome Measurement Information System Depression and Anxiety in Elective Knee Surgery Patients

“…Previous studies have found lower self-esteem and mood disturbances correlated with poorer ACL recovery. 19,20 Our findings demonstrate the impact psychologic distress on postoperative function in a wider surgical cohort. Given that the most common primary CPT code in the study cohort was ACL reconstruction, this suggests that hindered return to sport and recovery seen in those with mental health conditions may be secondary to poorer postoperative function as measured by PROMIS PF and IKDC.…”

Current study on the influence of psychological factors on returning to sports after ACLR

“…Tripp et al. [ 81 ] used the short version of the POMS scale (S-POMS) to find out that the more negative emotions, the lower confidence of athletes to return to sports, and the greater fear of reinjury [ 56 ].…”

“…Vutescu et al. [ 56 ] considered that psychological factors, including self-esteem, were related to the RTS potential of young athletes.…”

Does fear of re-injury affect the self-perceived level of lower limb functionality among soccer players with ACL reconstruction?: A cross-sectional study

“…[16] Variation exists in the risk of injury, which suggests the presence of specific quality indicators or rehabilitation milestones that potentially impact RTS outcomes. [16,17] Other than the surgical methods used for ACLR, other important factors influence recovery and RTS in PSPs, including age, [18] gender, [18][19][20] body mass index (BMI), [21] level of physical therapy, [22] rehabilitation protocol, [23] intent to RTS, [24] and psychological readiness. [25] The post-ACLR RTS rate among athletes younger than 25 is higher than older athletes.…”