Psychological Aspects of Recovery Following Anterior Cruciate Ligament Reconstruction

Abstract

Recovery following anterior cruciate ligament reconstruction is an arduous process that requires a significant mental and physical commitment to rehabilitation. Orthopaedic research in recent years has focused on optimizing anterior cruciate ligament surgical techniques; however, despite stable anterior cruciate ligament reconstructions, many athletes still never achieve their preinjury ability or even return to sport. Psychological factors associated with patient perceptions and functional outcomes following anterior cruciate ligament reconstruction are important to acknowledge and understand. Issues related to emotional disturbance, motivation, self-esteem, locus of control, and self-efficacy can have profound effects on patients' compliance, athletic identity, and readiness to return to sport. The psychological aspects of recovery play a critical role in functional outcomes, and a better understanding of these concepts is essential to optimize the treatment of patients undergoing anterior cruciate ligament reconstruction, particularly those who plan to return to sport. Identifying at-risk patients, encouraging a multidisciplinary approach to patient care, and providing early referral to a sports psychologist may improve patient outcomes and increase return-to-play rates among athletes.

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

“…Kinesiophobia (the heighted fear of movement and subsequent reinjury), 44 as well as increased awareness of the knee joint, is frequent after ACLR and is associated with lower levels of selfreported knee function and lower rates of return to sport. 32,45 Participants in this study demonstrated increased physical and mental awareness regarding their knees during activity. Awareness of the knee after ACLR encompassed participants' fear of reinjury and associated knee discomfort or perceived changes in functional performance.…”

“…13,[30][31][32][33] These factors are thought to influence the outcome of rehabilitation after injury. 30,34,35 Although psychological readiness to return to sport has been identified as a possible hindrance in returning to sport after injury, 4,14,15 few qualitative researchers have assessed the underlying psychological factors that may affect those considering a return to sport after ACLR.…”

Psyched Down

“…However, there is ample literature to support the proposition that psychological issues also have a tremendous influence on the ultimate success of our efforts to restore injured athletes to a state of optimal health and function. 6,26 In fact, some studies suggest that psychological factors may influence the risk of an injury occurring in the first place. 31 Because anterior cruciate ligament (ACL) rupture is a relatively common procedure that requires a prolonged recovery period and may potentially jeopardize an athletic career, it has constituted the setting for many of the psychological studies relevant to orthopaedic sports medicine.…”

“…23 This may be because higher level athletes are more heavily invested in their ''athletic identity.'' 2 Adolescent athletes are quite vulnerable to psychological distress following injury, 17,21,29 with a comparative study finding that they experienced more pain and catastrophizing (the tendency to assume the worst-case scenario 6 ) than adults. 29 Various psychological factors have been shown to affect the likelihood of an athlete returning to competition following ACL reconstruction.…”

Long-term quality of life following anterior cruciate ligament injury and reconstruction

“…Information assessing the impact of specific physical symptoms or impairments upon the QOL of the individual could be used to guide individualised management strategies to optimise post-operative outcomes. An ACLR can have long-lasting physical and psychological ramifications and has associated costs, risks and potential complications (Ahn et al, 2012;Ardern et al, 2012a;Christino, Fantry, & Vopat, 2015;Everhart et al, 2015;Kartus et al, 2001;Mather et al, 2013). In order to weigh-up the risks, costs and benefits, surgeons and patients may attempt to predict the likely impact that undergoing an ACLR may have on future QOL.…”