The Influence of Psychosocial Factors on Patients Undergoing Anterior Cruciate Ligament Reconstruction

Abstract

Context: Anterior cruciate ligament (ACL) injuries greatly impact patients in terms of future performance, reduced physical activity and athletic participation, and overall economic burden. Decades of research have investigated how to improve ACL reconstruction (ACLR) outcomes. Recently, there has been growing interest to understand the effects of psychosocial factors on patient outcomes. Study Design: Clinical review. Evidence Acquisition: A search of the PubMed database was performed in March 2023. Articles were reviewed by at least 2 authors to determine relevance. We highlighted publications of the past 5 years while incorporating previous pertinent studies. Level of Evidence: Level 5. Results: There is no standardization of psychosocial factors regarding ACLR. As such, there is a lack of consensus regarding which psychosocial measures to use and when. There is a need for clarification of the complex relationship between psychosocial factors and physical function. Despite this, psychosocial factors have the potential to help predict patients who are more likely to return to sport: (1) desire/motivation to return; (2) lower levels of kinesiophobia; (3) higher levels of self-efficacy, confidence, and subjective knee function; (4) risk acceptance; and (5) social support. However, there are no standardized interventions to improve psychosocial factors after ACLR. Conclusion: Psychosocial factors affect outcomes after ACLR. However, the interplay between psychosocial factors and physical function is complex. There is emerging evidence that testing and interventions may improve ACLR outcomes. There is a lack of standardized interventions to determine or improve psychosocial factors after ACLR. Further research is needed to identify psychosocial factors and to develop standardized interventions for clinicians to implement to improve clinical outcomes.

Psychological aspects associated with ACL rehabilitation and recurrence in football players: a systematic review

“…Conversely, the most common reasons for not returning were lack of confidence in the knee and fear of reinjury. These factors are comparable to those identified in other reviews (Longo et al, 2023;Momaya et al, 2024;Nwachukwu et al, 2019). For example, Nwachukwu et al (2019) reported the most common reasons were fear of reinjury, lack of confidence in the knee, depression, and lack of interest or motivation.…”

“…For example, Nwachukwu et al (2019) reported the most common reasons were fear of reinjury, lack of confidence in the knee, depression, and lack of interest or motivation. Momaya et al (2024) identified motivation to return, lower levels of kinesiophobia, higher levels of self-efficacy, confidence and subjective knee function, risk acceptance and social support as factors that might predict athletes more likely to RTP. In contrast to previous reviews, personality factors as "adventure seeking" and "personal standards" related to RTP were found in this study.…”

“…Longo et al (2023) found that the main reasons for not RTP were concerns about reinjury and pain, whereas self-efficacy, psychological will, and age were associated with better functional outcomes. Other factors that may help predict which athletes are more likely to RTP include motivation to return, lower levels of kinesiophobia, higher levels of self-efficacy, confidence and subjective knee function, risk acceptance and social support (Momaya et al, 2024). In a recent meta-analysis of 3744 patients, Xiao et al (2023) found no significant differences in the self-reported knee function of athletes who had RTP compared to those who had not after ACL surgery.…”

“…Although there are reviews in the literature on this topic (Longo et al, 2023;Momaya et al, 2024;Nwachukwu et al, 2019), they generally include studies with different types of sports, making it difficult to identify football-specific factors. Football is an intense sport where there are quick and sudden changes of direction, jumps and landings with impact and physical contact with other players.…”