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Psychological Responses Matter in Returning to Preinjury Level of Sport After Anterior Cruciate Ligament Reconstruction Surgery
Open accessAbstract
Background: Up to two-thirds of athletes may not return to their preinjury level of sport by 12 months after anterior cruciate ligament (ACL) reconstruction surgery, despite being physically recovered. This has led to questions about what other factors may influence return to sport. Purpose: To determine whether psychological factors predicted return to preinjury level of sport by 12 months after ACL reconstruction surgery. Study Design: Case control study; Level of evidence, 3. Methods: Recreational and competitive-level athletes seen at a private orthopaedic clinic with an ACL injury were consecutively recruited. The primary outcome was return to the preinjury level of sports participation. The psychological factors evaluated were psychological readiness to return to sport, fear of reinjury, mood, emotions, sport locus of control, and recovery expectations. Participants were followed up preoperatively and at 4 and 12 months postoperatively. Results: In total, 187 athletes participated. At 12 months, 56 athletes (31%) had returned to their preinjury level of sports participation. Significant independent contributions to returning to the preinjury level by 12 months after surgery were made by psychological readiness to return to sport, fear of reinjury, sport locus of control, and the athlete’s estimate of the number of months it would take to return to sport, as measured preoperatively (χ 2 2 = 18.3, P < .001, classification accuracy = 70%) and at 4 months postoperatively (χ 2 4 = 38.7, P < .001, classification accuracy = 86%). Conclusion: 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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Kinesiophobia has been identified as a contributing factor for failure to return to sport.
“Finally, kinesiophobia has been identified by many as a contributing factor for failure to RTS (Ardern et al., 2013; Lentz et al., 2015; Nwachukwu et al., 2019).”
From The relationship between psychological readiness to return to sport and kinesiophobia in teens and young adults after anterior cruciate ligament reconstruction (2025) · cites this paper as Ardern et al., 2013
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Ardern, C. L., Taylor, N. F., Feller, J. A., & Webster, K. E. (2014) · British Journal of Sports Medicine · doi:10.1136/bjsports-2013-093398 · Cited by 1,465
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Metadata
- Authors
- Ardern, C. L., Taylor, N. F., Feller, J. A., Whitehead, T. S., & Webster, K. E.
- Affiliations
- La Trobe University (AU)
- OrthoSport Victoria, Epworth Richmond, Melbourne, Victoria, Australia
- Corresponding author
- Ardern, Clare L.
- Venue
- The American Journal of Sports Medicine
- Publisher
- SAGE Publications
- Published
- 2013-06-03
- Volume
- 41
- Issue
- 7
- Pages
- 1549-1558
- ISSN
- 0363-5465 (ISSN-L)
- 1552-3365
- OpenAlex
- W2143598259
- Cited by
- 660
- References
- 7
- Citations by year
- 2026: 61 · 2025: 69 · 2024: 64 · 2023: 64 · 2022: 68 · 2021: 58 · 2020: 52 · 2019: 52 · 2018: 47 · 2017: 31 · 2016: 29 · 2015: 30 · 2014: 30 · 2013: 3
- FWCI
- 29.32
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Locations
- The American Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
- Social Sciences › Psychology › Developmental and Educational Psychology › Sport Psychology and Performance
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Keywords
- anterior cruciate ligament reconstruction, return to sport, psychological readiness, fear of reinjury, recovery expectations, athletes, psychological factors, postoperative recovery, mood and emotions
- MeSH terms
- Adolescent, Adult, Athletic Injuries, Female, Follow-Up Studies, Humans, Knee Injuries, Male, Prospective Studies, Sports, Case-Control Studies, Recovery of Function, Young Adult, Anterior Cruciate Ligament Reconstruction
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