The DOI matches its Crossref record; 64 of the 64 references it cites were found in a registry or an index; 16 of the 36 sources its claims cite were checked for support.
Biopsychosocial profiles following ACL reconstruction: A latent class analysis of barriers to return-to-activity
Open accessAbstract
OBJECTIVE: Understanding of how biopsychosocial factors interrelate to affect recovery from ACL injuries is essential for improving patient outcomes. This research aimed to use Latent Class Analysis (LCA) to classify individuals post-ACL reconstruction into subgroups reflecting their particular biopsychosocial challenges to recovery. DESIGN: Cross-Sectional. METHODS: This multisite investigation included 134 ACLR patients approximately 6 months (5.6 months ± 1.8 SD) following surgery. The ACL Reasons scale, various Patient Reported Outcome (PRO), and performance-based measures were assessed. LCA was used to categorize patients into subgroups based on the ACL Reasons scale. Subgroups were then compared across demographic, PRO, and performance-based measures using one-way analysis of variance and chi-squared tests. RESULTS: LCA identified two distinct groups of patients who were less active after ACL reconstruction, characterized by varying levels of injury related fear, anxiety and depression. These groups reported lower outcomes and demonstrated reduced performance on hop tests in comparison to those who were as active as before their surgery. CONCLUSION: Patients less active post-surgery fall into two categories: one hindered by injury-related fear and symptoms, the other by mostly symptoms alone. Tailored interventions could enhance recovery, with one group possibly benefiting from psychological support and the other from a focus on functional and symptomatic treatment.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
In a multisite cross-sectional sample of 134 ACLR patients about 5.6 months post-surgery, latent class analysis identified two distinct less-active subgroups: one limited mainly by injury-related fear plus symptoms, and one limited mainly by symptoms. Both less-active groups had poorer patient-reported outcomes and single-leg hop symmetry than patients who were as active as before surgery.
Key findings
- Among 105 patients who were less active after ACLR, LCA identified two subgroups: a fear/symptom-limited group (n = 75; 71%) primarily endorsing fear of injury, concern that activity would worsen knee health, and fear of knee symptoms/movement, and a symptom-limited group (n = 30; 29%) primarily endorsing knee symptoms such as pain, swelling, locking, and catching.
- Of the full 134-patient sample, 22% reported being “as active” as before ACLR and were excluded from LCA but retained as a reference group; this as-active group was on average ~1.75 months further out from surgery than both limited groups (p < 0.01).
- The fear/symptom-limited group had the lowest psychological readiness (ACL-RSI) and highest kinesiophobia (TSK-11), anxiety, and depression among all groups. Both less-active groups had inferior PROs and single-leg hop LSI compared with the as-active group, while perceived and performance-based function did not differ between the two limited groups.
- Quadriceps strength symmetry did not differ among groups, and all groups were below 90% quadriceps strength symmetry. The as-active group scored best and above all thresholds except isokinetic quadriceps LSI.
Methods
- Multisite cross-sectional study of 134 patients aged 13–35 years who had primary, unilateral ACLR 3–12 months before assessment; mean time from surgery was 5.6 months ± 1.8 SD, mean age was 20.2 years ± 8.0 SD, and 55% were female.
- Patients completed the ACL Reasons scale, which begins with a screening item on current activity relative to pre-injury (“as active,” “as active but challenging,” or “less active”); those selecting less-active options completed 14 barrier items covering biopsychosocial variables.
- LCA used binary manifest variables from the ACL Reasons scale with the Polytomous Variable Latent Class Analysis package in R; models with 2–10 classes were assessed using BIC and AIC, and the lowest BIC model was selected. Groups were compared on demographics, PROs, and performance measures using one-way ANOVA with Tukey post-hoc tests and chi-squared tests, with p < 0.05.
Limitations
- The paper states that LCA has inherent limitations, including inaccurate class assignments, inability to determine precise class sizes, and risk of “naming fallacy” in which class labels may not accurately reflect all members of a group.
- The paper states the study was cross-sectional and represents a snapshot in time when one group was further postoperative, potentially influencing profiling; most participants were evaluated between 5 and 7 months post-ACLR, but the range may have influenced subgroup classification.
- The paper states the single-item activity screener may not fully capture return-to-activity behavior, and sport played at injury was not consistently recorded, limiting accounting for sport-specific recovery factors. Evident from the text: the symptom-limited subgroup was small (n = 30), and the cross-sectional design cannot determine whether profiles change over time or relate to longer-term outcomes such as return-to-activity, reinjury risk, or osteoarthritis development.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
16 of 36 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured
- Premisecitation
LCA facilitates identification of distinct patient subgroups, to inform specific recovery trajectories shared among individuals based on common attributes.
“LCA facilitates identification of distinct patient subgroups, to inform specific recovery trajectories shared among individuals based on common attributes.35,47”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [35] Muthén, 2002, Beyond SEM: General latent variable modeling, Behaviormetrika source
The latent class analysis section says LCA finds clusters of similar individuals, and the latent class growth analysis section says individuals can be grouped by their trajectories over time. The paper discusses disease processes in medicine, but it does not specifically establish patient recovery trajectories; it describes trajectory grouping through latent class growth analysis rather than LCA alone. Page numbers are unavailable in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [47] Shaw, 2017, Trends in pediatric and adolescent anterior cruciate ligament injuries in Victoria, Australia 2005–2015, Int J Env Res Public Health source
The Materials and Methods section describes an analysis of Victorian hospital admissions for ACL injuries, while the Discussion addresses injury trends and prevention. Searches for latent class analysis, patient subgroups, and shared recovery trajectories found no passage addressing the attributed claim. (LLM, conf=0.76)
Experimental — accuracy not yet measured
- Premisecitation
These constructs-alongside physical function measures like strength and hop performance-offer complementary but distinct insights into the barriers patients face during rehabilitation.
“These constructs—alongside physical function measures like strength and hop performance—offer complementary but distinct insights into the barriers patients face during rehabilitation.39”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [39] Ohji, 2021, Injury-related fear in athletes returning to sports after anterior cruciate ligament reconstruction - A quantitative content analysis of an open-ended questionnaire, Asia-Pac J Sports Med Arthrosc Rehabil Technol source
The Clinical implication section says that assessing six injury-related fear concepts may help plan rehabilitation, and the Surgical technique and postoperative rehabilitation section uses strength and single-leg hop measures as criteria for partial sport participation. The paper does not assess whether the fear concepts and physical measures provide complementary but distinct insights into patients’ barriers. (LLM, conf=0.83)
Experimental — accuracy not yet measured
- Premisecitation
LCA holds significant potential to uncover complicated recovery profiles following ACL injuries.
“Building on progress in biopsychosocial characterization, recent developments in person-centered statistical methodologies, particularly latent class analysis (LCA), hold significant potential to uncover complicated recovery profiles following ACL injuries.21,27,35,42,53”
Quote in the paperNot a substantial claim2 of 5 sources checked- cites [21] Irrgang, 2001, Development and validation of the international knee documentation committee subjective knee form, The American Journal of Sports Medicine source
- cites [27] Lentz, 2015, Comparison of physical impairment, functional, and psychosocial measures based on fear of reinjury/lack of confidence and return-to-sport status after ACL reconstruction, The American Journal of Sports Medicine source
- cites [35] Muthén, 2002, Beyond SEM: General latent variable modeling, Behaviormetrika source
Section 3.1.1 shows latent class analysis identifying distinct behavioral profiles, and the latent class growth analysis section describes classes with different trajectories over time. These passages support LCA’s general potential to uncover complex profiles, but the paper does not address recovery following ACL injuries. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [42] Pilkonis, 2011, Item banks for measuring emotional distress from the patient-reported outcomes measurement information system (PROMIS®): Depression, anxiety, and anger, Assessment source
The Results section describes confirmatory factor analysis of depression, anxiety, and anger items; the Discussion addresses item-bank models, not latent class analysis. Searches for LCA, recovery profiles, and ACL injuries found no passage in our copy addressing the claim. (LLM, conf=0.76)
Experimental — accuracy not yet measured - cites [53] Tegner, 1985, Rating systems in the evaluation of knee ligament injuries, Clinical orthopaedics source
- Premisecitation
Psychological readiness may serve as a more reliable indicator of successful return-to-activity compared to functional performance.
“Yet psychological readiness may serve as a more reliable indicator of successful return-to-activity compared to functional performance.26,39,63”
Quote in the paperSubstantial claim2 of 3 sources checked- cites [26] Lee, 2021, Latent profile analysis of blood marker phenotypes and their relationships with clinical pain and interference reports in people with acute musculoskeletal trauma, Can J Pain source
The Methods section measures functional recovery using pain and interference scores, while the Results compare those scores across blood-marker groups. Searches for psychological readiness, return to activity, and a comparison with functional performance found no passage addressing the claimed relative reliability. (LLM, conf=0.76)
Experimental — accuracy not yet measured - cites [39] Ohji, 2021, Injury-related fear in athletes returning to sports after anterior cruciate ligament reconstruction - A quantitative content analysis of an open-ended questionnaire, Asia-Pac J Sports Med Arthrosc Rehabil Technol source
The Introduction (page unavailable) describes fear of movement and re-injury as psychological factors inhibiting return to sport, and reports greater fear among athletes who did not return at their previous performance level. But the paper does not compare psychological readiness with functional performance as indicators of successful return; its fear questionnaire was administered after participants had returned to sport. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [63] Xiao, 2023, Patients who return to sport after primary anterior cruciate ligament reconstruction have significantly higher psychological readiness: A systematic review and meta-analysis of 3744 patients, The American Journal of Sports Medicine source
- Premisecitation
The selected time window (3-12 months post-ACLR) reflects a critical period in rehabilitation where patients are commonly assessed for return-to-activity decisions.
“The selected time window (3–12 months post-ACLR) reflects a critical period in rehabilitation where patients are commonly assessed for return-to-activity decisions.”
Quote in the paperSubstantial claim3 of 3 sources checked- cites [26] Lee, 2021, Latent profile analysis of blood marker phenotypes and their relationships with clinical pain and interference reports in people with acute musculoskeletal trauma, Can J Pain source
The Methods section describes follow-up after general musculoskeletal injury, and the Introduction discusses pain-recovery trajectories over 12 months. Neither addresses rehabilitation after ACL reconstruction or when return-to-activity decisions are commonly made; searches for ACLR and return-to-activity assessment found no relevant passage. (LLM, conf=0.74)
Experimental — accuracy not yet measured - cites [28] Lo, 2025, Integrating psychological and physical assessments to obtain optimal return-to-sport outcomes after ACL reconstruction: A systematic review and network meta-analysis, J Sports Sci source
The Study limitations section says most included studies focused on a 12-month return-to-sport criterion, and the study summaries describe an assessment at 6 months that predicted return at one year. This supports assessments during part of the proposed window, but the paper does not establish 3–12 months as a critical period in which patients are commonly assessed for return-to-activity decisions. Page numbers are unavailable in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measured - cites [56] Webster, 2018, Development and validation of a short version of the anterior cruciate ligament return to sport after injury (ACL-RSI) scale, Orthop J Sports Med source
The Methods (Participants; page unavailable) describe criteria for running at 12 weeks, noncontact training at 6 months, and return to play at 9 months. The Methods (Procedures and Analysis; page unavailable) also assess psychological readiness at 6 months and return-to-sport status at 12 months. These passages support the relevance of the 3–12-month window in this study, but do not establish that patients are commonly assessed throughout that window or explicitly characterize it as a critical rehabilitation period. (LLM, conf=0.83)
Experimental — accuracy not yet measured
- Premisecitation
Despite their known relevance, these psychosocial dimensions are not consistently incorporated into clinical decision-making.
“Despite their known relevance, these psychosocial dimensions are not consistently incorporated into clinical decision-making.8”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [8] Betsch, 2022, Wide variability in return-to-sport criteria used by team physicians after anterior cruciate ligament reconstruction in elite Athletes-A qualitative study, Arthrosc Sports Med Rehabil source
- Study design and conductcitation
A sample size of approximately 100 and alpha of .05 would achieve 80% power for LCA.
“Power curves from simulations studies using LCA have shown that a sample size of approximately 100 and alpha of .05 would achieve 80% power.13”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [13] Dziak, 2014, Effect size, statistical power, and sample size requirements for the bootstrap likelihood ratio test in latent class analysis, Struct Equ Model Multidiscip J source
In “An Example of Simulated Power for the BLRT” (page not available in our copy), the paper says that at α = .05, about 80% power would be achieved with N slightly over 100 in one simulated scenario. The citing sentence omits that condition and presents the sample size as sufficient for LCA generally; the same section reports power ranging from 4% to 99% at N = 100 across other scenarios. (LLM, conf=0.88)
Experimental — accuracy not yet measured
- Premisecitation
Psychological factors such as fear of reinjury, anxiety, and confidence have consistently been associated with recovery trajectories following ACLR, often exerting a greater influence on return-to-activity than physical impairments alone.
“Psychological factors such as fear of reinjury, anxiety, and confidence have consistently been associated with recovery trajectories following ACLR, often exerting a greater influence on return-to-activity than physical impairments alone.29”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [29] Lynch, 2015, Consensus criteria for defining “successful outcome” after ACL injury and reconstruction: A Delaware-Oslo ACL cohort investigation, British Journal of Sports Medicine source
The Discussion (Outcome Criteria Achieving Consensus; page unavailable) says fear of reinjury can affect return to sport and that confidence can affect post-return ability, even when knee function permits participation. It does not address anxiety or establish consistent associations with recovery trajectories, nor does it show that psychological factors generally have a greater influence than physical impairments. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Findingown data
Latent Class Analysis on ACLR patients who were less active post-surgery revealed two groups, primarily separated by fear of reinjury, anxiety, and depression.
“Latent Class Analysis on ACLR patients who were less active post-surgery revealed two groups, primarily separated by fear of reinjury, anxiety, and depression.”
Quote in the paperSubstantial claim - Findingown data
The other subgroup (n = 30; 29%) primarily indicated that knee symptoms (e.g., pain, swelling, locking, catching) were the reason for not fully returning to activity (symptom-limited group).
“The other subgroup (n = 30; 29%) primarily indicated that knee symptoms (e.g., pain, swelling, locking, catching) were the reason for not fully returning to activity (symptom-limited group).”
Quote in the paperSubstantial claim - Findingown data
All groups were below 90% in their quadriceps strength symmetry.
“Interestingly, quadriceps strength symmetry did not differ among groups, and all groups were below 90% in their quadriceps strength symmetry.”
Quote in the paperSubstantial claim - Findingown data
Reasons such as lack of social support, financial resources, or rehabilitation resources were not often indicated as barriers for achieving pre-injury levels of physical activity in either group.
“Reasons such as lack of social support, financial resources, or rehabilitation resources were not often indicated as barriers for achieving pre-injury levels of physical activity in either group.”
Quote in the paperNot a substantial claim - Findingown data
Except for KOOS activity of daily living (ADL), clinical depression, and anxiety, the fear/symptom-limited group was below various PASS and cut-off thresholds.
“Except for KOOS activity of daily living (ADL), clinical depression, and anxiety, the fear/symptom-limited group was below various PASS and cut-off thresholds.”
Quote in the paperNot a substantial claim - Findingown data
The best fitting LCA model (BIC=1328.4, AIC=1251.4) of the remaining 105 patients revealed two distinct subgroups.
“The best fitting LCA model (Bayesian information criterion = 1328.4, AIC = 1251.4) of the remaining 105 patients revealed two distinct subgroups.”
Quote in the paperSubstantial claim - Findingown data
LCA identified two distinct groups of patients who were less active after ACL reconstruction, characterized by varying levels of injury related fear, anxiety and depression.
“LCA identified two distinct groups of patients who were less active after ACL reconstruction, characterized by varying levels of injury related fear, anxiety and depression.”
- Also stated in: § DISCUSSION · plain
“Our LCA conducted in patients from 2 to 24 months post-ACLR identified distinct subgroups of less-active patients, revealing that fear of reinjury, anxiety, and depression were the primary differentiators among these individuals.”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
The fear/symptom-limited group had similar pain, symptoms, perceived function, activity level (Tegner score change and Marx), and performance-based measures compared to the symptom-limited group.
“The fear/symptom-limited group had similar pain, symptoms, perceived function, activity level (Tegner score change and Marx), and performance-based measures compared to the symptom-limited group (Figure 2).”
- Also stated in: § DISCUSSION · plain
“Perceived and performance-based function did not differ between the limited groups.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Figure 2
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Also stated in: § DISCUSSION · plain
- Findingnone given
Both groups had poorer PROs and hop test scores than those who resumed their activities.
“Both groups had poorer PROs and hop test scores than those who resumed their activities.”
Quote in the paperSubstantial claim - Findingown data
The symptom-limited group also was below or at the various PASS or cut-off thresholds except for clinical depression and anxiety.
“The symptom-limited group also was below or at the various PASS or cut-off thresholds except for clinical depression and anxiety.”
Quote in the paperNot a substantial claim - Findingown data
22% of the total sample primarily identified symptoms as the main obstacles to regaining their former activity level.
“A smaller proportion of patients was either as active as before ACLR (22%) or primarily identified symptoms (22%) as the main obstacles to regaining their former activity level.”
Quote in the paperNot a substantial claim - Findingown data
The as-active group was, on average, ~1.75 months further out from their ACLR surgery compared to both limited groups (p < 0.01).
“The as-active group was, on average, ~1.75 months further out from their ACLR surgery compared to both limited groups (p < 0.01).”
Quote in the paperNot a substantial claim - Findingown data
In the total sample, 56% of patients reported fear-related concerns and symptoms as reasons for not returning to their previous levels of physical activity.
“In the total sample, 56% of patients reported fear-related concerns and symptoms as reasons for not returning to their previous levels of physical activity.”
Quote in the paperSubstantial claim - Findingown data
One group (n = 75; 71%) consisted of patients who primarily indicated fear of injury, concern that activity would worsen knee health, and fear of knee symptoms/movement as reasons for not fully returning to activity (fear/symptom-limited group).
“One group (n = 75; 71%) consisted of patients who primarily indicated the following reasons for not fully returning to activity: fear of injury, concern that activity would worsen knee health, and fear of knee symptoms/ movement (fear/symptom-limited group).”
Quote in the paperSubstantial claim - Findingown data
Quadriceps strength symmetry did not differ among groups.
“Interestingly, quadriceps strength symmetry did not differ among groups, and all groups were below 90% in their quadriceps strength symmetry.”
Quote in the paperSubstantial claim - Premisecitation
Higher LSI values for hop testing relative to isokinetic strength has been reported.
“Higher LSI values for hop testing relative to isokinetic strength has been reported.37”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [37] Nylund-Gibson, 2018, Ten frequently asked questions about latent class analysis, Transl Issues Psychol Sci source
- Premisecitation
Several of the PROs (e.g., ACL-RSI, IKDC, KOOS, PROMIS) have documented psychometric properties in this population, including internal consistency, construct validity, and responsiveness to change.
“Additionally, several of the PROs (e.g., ACL-RSI, IKDC, KOOS, PROMIS) have documented psychometric properties in this population, including internal consistency, construct validity, and responsiveness to change.18”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18] Gagnier, 2018, Psychometric properties of patient-reported outcome measures for use in patients with anterior cruciate ligament injuries: A systematic review, JBJS Reviews source
- Premisecitation
In its original validation study, the ACL Reasons scale showed good convergent validity when compared with scales including the Knee Injury and Osteoarthritis Outcome Scores, ACL-RSI and Tampa Scale for Kinesiophobia.
“In its original validation study, the scale showed good convergent validity when compared with scales including the Knee Injury and Osteoarthritis Outcome Scores, ACL-RSI and Tampa Scale for Kinesiophobia.24”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [24]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationcitation
The paper's findings align with prior work identifying psychological readiness and symptom burden as key barriers to return-to-activity.
“our findings align with prior work identifying psychological readiness and symptom burden as key barriers to return-to-activity.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Ardern et al. 201751
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Lentz et al.201528
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Arhos et al. 2023 identified subgroups of ACL injury patients differentiated by age and perceived function.
“More recent work by Arhos et al.20233, using mixture-modeling, identified subgroups of ACL injury patients differentiated by age and perceived function”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Arhos et al.20233
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Fear of reinjury and low confidence are major contributors to delayed or failed return to sport.
“Ardern et al. 201751 and Lentz et al.201528 similarly reported that fear of reinjury and low confidence are major contributors to delayed or failed return to sport.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Ardern et al. 201751
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Lentz et al.201528
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Probably not a substantial claim. 8
- It may state two separate claims as one. 16
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
PremisecitationLCA has inherent limitations, such as inaccurate class assignments and the inability to determine precise class sizes, compounded by the risk of "naming fallacy" in which class labels may not accurately reflect characteristics of all members of a group.
“LCA is a robust modeling approach, however this type of modeling has inherent limitations, such as inaccurate class assignments and the inability to determine precise class sizes, compounded by the risk of “naming fallacy” in which class labels may not accurately reflect characteristics of all members of a group.36”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [36] Nagai, 2020, Hop tests can result in higher limb symmetry index values than isokinetic strength and leg press tests in patients following ACL reconstruction, Knee Surgery, Sports Traumatology, Arthroscopy source
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
It may state two separate claims as one.
PremisecitationApplication of latent and other mixture modeling techniques in ACL research has historically been constrained, often focusing on a singular variable such as delineating subgroups based on IKDC trajectory, or neglecting critical psychosocial variables such as fear of reinjury.
“Although application of latent and other mixture modeling techniques in ACL research has historically been constrained—often focusing on a singular variable such as delineating subgroups based on International Knee Documentation Committee (IKDC) trajectory,42 or neglecting critical psychosocial variables such as fear of reinjury3—the landscape is evolving.”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [42] Pilkonis, 2011, Item banks for measuring emotional distress from the patient-reported outcomes measurement information system (PROMIS®): Depression, anxiety, and anger, Assessment source
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured - cites [3] Arhos, 2023, Clinically relevant subgroups among athletes who have ruptured their anterior cruciate ligaments: A Delaware-Oslo cohort study, Arthritis Care & Research source
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
It may state two separate claims as one.
Findingown dataThe two less-active groups reported lower outcomes and demonstrated reduced performance on hop tests in comparison to those who were as active as before their surgery.
“These groups reported lower outcomes and demonstrated reduced performance on hop tests in comparison to those who were as active as before their surgery.”
- Also stated in: § DISCUSSION · plain
“The two less-active groups had inferior PROs and single-leg hop LSI compared to the as-active group.”
Quote in the paperSubstantial claim- Also stated in: § DISCUSSION · plain
It may state two separate claims as one.
Findingown dataIn total, 22% of the sample indicated they were "as active" as before ACLR and thus were not included in LCA but were included in the outcome comparison (as-active group).
“In total, 22% of the sample indicated they were “as active” as before ACLR and thus were not included in LCA but were included in the outcome comparison (as-active group).”
Quote in the paperNot a substantial claimIt may state two separate claims as one.
Findingown dataThe as-active group scored best and above all thresholds on all outcome measures except isokinetic quadriceps LSI.
“The as-active group scored best and above all thresholds (red dashed lines in Figure 2) on all outcome measures except isokinetic quadriceps LSI.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Figure 2
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
It may state two separate claims as one.
Findingown dataMany reported physical symptoms as a key barrier to regaining pre-surgery activity levels, while others highlighted fear.
“Many reported physical symptoms as a key barrier to regaining pre-surgery activity levels, while others highlighted fear.”
Quote in the paperSubstantial claimIt may state two separate claims as one.
Findingown dataThe fear/symptom-limited group had the lowest psychological readiness (measured by ACL-RSI) and highest kinesiophobia (measured by TSK-11), anxiety, and depression amongst all groups.
“The fear/symptom-limited group had the lowest psychological readiness (measured by ACL-RSI) and highest kinesiophobia (measured by TSK-11), anxiety, and depression amongst all groups (Figure 2).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Figure 2
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
It may state two separate claims as one.
Findingown dataAge, height, weight, proportion female, and pre-ACLR Tegner score did not significantly differ among groups.
“Age, height, weight, proportion female, and pre-ACLR Tegner score did not significantly differ among groups (Table 1).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Table 1
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
It may state two separate claims as one.
Findingown dataPatients less active post-surgery fall into two categories: one hindered by injury-related fear and symptoms, the other by mostly symptoms alone.
“Patients less active post-surgery fall into two categories: one hindered by injury-related fear and symptoms, the other by mostly symptoms alone.”
Quote in the paperSubstantial claim- Rests on an assumption: The study sample is representative of the broader population of ACLR patients who are less active post-surgery.
Probably not a substantial claim.
PremisecitationA widely accepted model of psychological response to sport injury indicates that cognitive, emotional, and behavioral reactions to sport injury are interrelated and influenced by the dynamic interplay of personal (biological and psychological) and situational variables.
“A widely accepted model of psychological response to sport injury indicates that cognitive, emotional, and behavioral reactions to sport injury are interrelated and influenced by the dynamic interplay of personal (biological and psychological) and situational variables.61”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [61] Wiese-bjornstal, 1998, An integrated model of response to sport injury: Psychological and sociological dynamics, Journal of Applied Sport Psychology source
Probably not a substantial claim. It may be too vague to check against evidence.
PremisecitationThe ACL Reasons scale is a beneficial tool to potentially define subgroups within patients who have an ACL injury with similar reasons for not returning to pre-injury levels of physical activity.
“The ACL Reasons scale is a beneficial tool to potentially define subgroups within patients who have an ACL injury with similar reasons for not returning to pre-injury levels of physical activity, which could enable a more tailored approach to recovery.24”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [24]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
It may state two separate claims as one.
Study design and conductnone givenMost participants were evaluated between 5 and 7 months post-ACLR, and this range may have influenced subgroup classification.
“Although most participants were evaluated between 5 and 7 months post-ACLR, this range may have influenced subgroup classification.”
Quote in the paperNot a substantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
PremisecitationThe prior study's contributions are tempered by its limitations, including considerable variability in the timing of follow-up assessments, absence of objective functional measures, and potential selection bias stemming from low response rates.
“However, the study’s contributions are tempered by its limitations, including considerable variability in the timing of follow-up assessments, absence of objective functional measures, and potential selection bias stemming from low response rates.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [25] Langford, 2009, A prospective longitudinal study to assess psychological changes following anterior cruciate ligament reconstruction surgery, British Journal of Sports Medicine source
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
Study design and conductnone givenThe single-item activity screener used to determine completion of the ACL Reasons scale may not fully capture the complexity of return-to-activity behavior and could introduce variability in group classification.
“Additionally, the single-item activity screener used to determine completion of the ACL Reasons scale may not fully capture the complexity of return-to-activity behavior and could introduce variability in group classification.”
Quote in the paperNot a substantial claimProbably not a substantial claim.
InterpretationcitationThe study extends prior work by incorporating psychological and biopsychosocial barriers to activity, providing a complementary perspective on recovery profiling.
“our study extends this work by incorporating psychological and biopsychosocial barriers to activity, providing a complementary perspective on recovery profiling.”
Quote in the paperSubstantial claim- Rests on an assumption: Few studies have used latent class analysis to examine biopsychosocial recovery profiles post-ACLR.
It may state two separate claims as one.
PremisecitationThe ACL Reasons scale has demonstrated face and content validity and is designed to align with theoretical models of rehabilitation behavior, such as the fear-avoidance and biopsychosocial models.
“The ACL Reasons scale has demonstrated face and content validity and is designed to align with theoretical models of rehabilitation behavior, such as the fear-avoidance and biopsychosocial models.”
Quote in the paperSubstantial claimProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
Study design and conductreasoningThis study was cross-sectional and represents a snapshot in time when one group was further postoperative-ACLR, thus potentially influencing the profiling results.
“Another limitation was that this study was cross-sectional and represents a snapshot in time when one group was further postoperative-ACLR, thus potentially influencing the profiling results.”
Quote in the paperNot a substantial claimIt may state two separate claims as one.
PremisereasoningThe ACL Reasons scale offers a more comprehensive assessment than the ACL-RSI, including psychological factors like injury-related fear and confidence and also evaluating symptoms, motivation, and social factors.
“In contrast to the ACL-RSI, the ACL Reasons scale offers a more comprehensive assessment that not only includes psychological factors like injury-related fear and confidence but also evaluates symptoms, motivation, and the influence of social factors on an individual’s return-to-activity.”
Quote in the paperSubstantial claimIt may state two separate claims as one.
Study design and conductown dataThe sport played at the time of injury was not consistently recorded across participants and was therefore not analyzed, which limits our ability to account for sport-specific recovery factors.
“Finally, the sport played at the time of injury was not consistently recorded across participants and was therefore not analyzed, which limits our ability to account for sport-specific recovery factors.”
Quote in the paperNot a substantial claimProbably not a substantial claim.
PremisecitationModel-based subgrouping like LCA is intended to be hypothesis-generating by suggesting intervention targets, including when and who needs intervention.
“As such, model-based subgrouping like LCA is intended to be hypothesis-generating by suggesting intervention targets, including when and who needs intervention.9”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [9]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
The authors state this as an assumption.
Missing data were missing completely at random.
“Missing data were handled under the assumption that they were missing completely at random, thus we employed listwise deletion for statistical analyses.”
The paper relies on this without support.
The study sample is representative of the broader population of ACLR patients who are less active post-surgery.
“Patients less active post-surgery fall into two categories: one hindered by injury-related fear and symptoms, the other by mostly symptoms alone.”
The paper relies on this without support.
Few studies have used latent class analysis to examine biopsychosocial recovery profiles post-ACLR.
“While few studies have used latent class analysis to examine biopsychosocial recovery profiles post-ACLR”
The paper relies on this without support.
Comprehensive evaluation and integration of biopsychosocial characteristics throughout ACL injury rehabilitation and recovery following ACLR remains a challenge.
“A remaining challenge is comprehensive evaluation and integration of biopsychosocial characteristics throughout ACL injury rehabilitation and recovery following ACLR.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Postoperative time range conflicts with eligibility criteria
MajorThe discussion says the analysis included patients 2 to 24 months after ACL reconstruction, but the methods restrict eligibility to 3 to 12 months after surgery.
“Our LCA conducted in patients from 2 to 24 months post-ACLR identified distinct subgroups of less-active patients”
“Participants were included in the analysis if they were 13–35 years old and had undergone primary, unilateral ACLR 3–12 months prior to assessment.”
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Vitor, E. B., & de Fontes, P. A. D. S. (2025) · Research Society and Development · doi:10.33448/rsd-v14i10.49704 · Cited by 38
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Return to Running (RTR) nach Rekonstruktionen des vorderen Kreuzbandes – ein narrativer Review
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Impactos da reabilitação precoce após reconstrução do LCA no retorno esportivo
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Self-citation
Metadata
- Authors
- Petushek, E., Harkey, M. S., Santiago, K., Stamm, A., Baez, S., Diekfuss, J. A., Myer, G. D., & Kuenze, C.
- Affiliations
- Michigan Technological University (US)
- Michigan State University (US)
- University of North Carolina at Chapel Hill (US)
- Emory University (US)
- Georgia Institute of Technology (US)
- University of Virginia (US)
- Corresponding author
- Petushek, Erich
- ORCID
- Venue
- Physical Therapy in Sport
- Publisher
- Elsevier BV
- Published
- 2025-09
- Volume
- 75
- Pages
- 144-150
- ISSN
- 1466-853X (ISSN-L)
- PMC
- PMC12710663
- OpenAlex
- W4413159782
- Cited by
- 5
- References
- 62
- Citations by year
- 2026: 3 · 2025: 2
- FWCI
- 3.50
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Physical Therapy in Sport (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Digital Commons - Michigan Tech (Michigan Technological University) (submittedVersion, cc-by)
- Funders
- US Department of Defense (W81XWH22C0062)
- National Institutes of Health
- U.S. Department of Veterans Affairs
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR076153, R61AT012421, R01AR077248, R01AR070474, R01AR055563, U01AR067997)
- Arthrex
- Arthritis Foundation
- Administration for Community Living
- Topics
- Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Foot and Ankle Surgery
- Keywords
- anterior cruciate ligament reconstruction, return to activity, biopsychosocial factors, anxiety, depression, patient-reported outcomes, hop tests, postoperative recovery, patient subgroups, psychological support
- MeSH terms
- Return to Sport, Anterior Cruciate Ligament Injuries, Patient Reported Outcome Measures, Latent Class Analysis, Adolescent, Adult, Anxiety, Cross-Sectional Studies, Depression, Fear, Female, Humans, Male, Recovery of Function, Young Adult, Anterior Cruciate Ligament Reconstruction
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-11-08, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-11-08 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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