The DOI matches its Crossref record; 45 of the 45 references it cites were found in a registry or an index; 13 of the 28 sources its claims cite were checked for support.
Determinants of Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction
Open accessAbstract
Background: Psychological and physical factors influence recovery after anterior cruciate ligament (ACL) reconstruction (ACLR). However, the relative contributions of psychological, subjective, and objective recovery measures to psychological readiness for return to sport remain unclear. Objective: To identify psychological, subjective, and objective recovery factors associated with psychological readiness to return to sport approximately 6 months after ACLR. Design: Cross-sectional study. Setting: University laboratory. Patients or Other Participants: A total of 58 participants (31 [53%] females; age = 18.95 ± 5.20 years), who completed standardized postoperative rehabilitation and follow-up testing at approximately 6 months after primary unilateral ACLR, were included. Main Outcome Measure(s): We measured psychological readiness using the ACL-Return to Sport after Injury (ACL-RSI) scale and conducted hierarchical regression analyses to examine predictors of psychological readiness across 4 conceptually ordered domains: (1) demographics (age, sex, and time since surgery), (2) generalized anxiety (Patient-Reported Outcomes Measurement Information System Anxiety Scale) and kinesiophobia (Tampa Scale for Kinesiophobia 11), (3) knee-specific patient-reported outcomes (Knee Injury and Osteoarthritis Outcomes Scale [KOOS] subscales of Pain, Symptoms, Quality of Life [QoL], and Sport), and (4) objective functional measures (quadriceps strength and single-legged hop symmetry). We conducted hierarchical linear regression in conceptually ordered blocks. Results: Demographic factors explained minimal variance in psychological readiness (1%–4%). Generalized anxiety contributed an additional 18.1%, and kinesiophobia (Tampa Scale for Kinesiophobia 11, 22.3%), QoL (KOOS-QoL, 9.8%), and subjective sport function (KOOS-Sport, 5.3%) emerged as the strongest incremental predictors. Pain, symptoms, and objective function contributed little additional variance. The full model explained 70.5% of the variance in ACL-RSI scores (adjusted R 2 = 0.64, P < .001), and cross-validation produced a comparable R 2 (0.61), indicating good model generalizability and minimal overfitting. Conclusions: Fear-related beliefs and perceived function exerted stronger influences on psychological readiness after ACLR than objective functional symmetry. These findings highlight the importance of biopsychosocial assessment models and sport-specific psychological measures to enhance return-to-sport decision-making and long-term recovery outcomes.
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TL;DR
This cross-sectional study examined psychological, subjective, and objective factors associated with psychological readiness to return to sport about 6 months after ACL reconstruction. Kinesiophobia, knee-related quality of life, and perceived sport function were the strongest predictors, while pain/symptoms and objective strength/hop symmetry contributed little unique variance.
Key findings
- The overall model explained 70.5% of variance in ACL-RSI scores (adjusted R² = 0.64, P < .001; cross-validated R² = 0.61).
- In hierarchical regression, kinesiophobia added 22.3% variance and generalized anxiety added 18.1%; KOOS-QoL added 9.8%, KOOS-Sport added 5.3%, and KOOS-Pain/Symptoms added 2.7%. Objective measures contributed little (quadriceps strength symmetry = −0.6%; single-legged hop symmetry = 0.6%).
- Variance decomposition showed the strongest overall contributors were KOOS-QoL (18.8%), KOOS-Sport (14.8%), and kinesiophobia (13.3%), followed by KOOS-Pain/Symptoms (9.3%), hop-distance symmetry (5.2%), and generalized anxiety (5.0%).
- Largest unique contributors were KOOS-Sport (4.9%), kinesiophobia (3.6%), and KOOS-QoL (3.3%); all other predictors explained <1.5% additional variance.
Methods
- Single-site cross-sectional analysis within a larger ongoing longitudinal study; 58 participants (31 [53%] female; age = 18.95 ± 5.20 years; time since surgery = 6.32 ± 1.90 months) aged 13–36 years who had primary unilateral ACLR 3–12 months earlier.
- Primary outcome was psychological readiness to return to sport measured by the ACL-RSI. Predictors included demographics, PROMIS Anxiety, Tampa Scale for Kinesiophobia 11, KOOS subscales, quadriceps strength symmetry, and single-legged hop-distance symmetry.
- Hierarchical linear regression entered predictors in conceptual blocks; variance decomposition used the Lindeman, Merenda, and Gold method and semipartial R², with repeated 10-fold cross-validation (50 repeats).
Limitations
- The authors state that data came from a single clinical site, which may limit generalizability to broader ACLR populations with different rehabilitation practices, demographics, or sport demands.
- The authors state that the modest sample size (n = 58) reduced statistical power, limiting detection of smaller but clinically meaningful effects; smaller ΔR² values for KOOS-Pain/Symptoms and objective measures should be interpreted cautiously.
- The authors state that the cross-sectional design precluded causal or temporal conclusions, and that unmeasured constructs such as reinjury anxiety, motivation, coping style, or social support may account for additional variance.
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Claims the paper makes
14 Own method · 13 Own interpretation · 12 Own result · 4 Partly supported · 3 No full text of the sources · 1 Sources not found · 1 Not checked yet · accuracy not yet measured
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Psychological barriers such as fear of reinjury persist even in athletes who meet physical recovery criteria.19”
What the sources say
- Partly supportedcites [19] Mercurio AM, Scott EJ, Sugimoto D, et al. Assessing the impact of psychological readiness on performance and symmetry in functional testing after ACL reconstruction in pediatric and adolescent patients. Orthop J Sports Med. 2024;12(9):23259671241274768. doi:10.1177/23259671241274768 sourceExperimental — accuracy not yet measured
The paper’s background states that fear of reinjury can impede a young athlete’s return to preinjury fitness, and its Discussion reports an association between psychological readiness and hop-test performance after ACL reconstruction. It does not establish that fear persists specifically in athletes who have met physical recovery criteria; its Conclusion recommends assessing psychological readiness alongside functional measures. Page numbers are unavailable in our copy. (LLM, conf=0.84)
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“The KOOS-Pain/Symptoms contributed relatively little change to the model (2.7%)”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Generalized anxiety accounted for an additional 18.1% of variance”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Quadriceps strength and single-legged hop symmetry alone contributed minimally to psychological readiness”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“the KOOS-Sport explained an additional 5.3%”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“the KOOS-QoL added 9.8%”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“kinesiophobia added 22.3%”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Demographic factors explained a small proportion of variance in psychological readiness to return to sport (age = 1.4%, sex = 0.3%, and time since surgery = 4.2%).”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Together, these findings reinforced that kinesiophobia and perceived knee function and QoL rather than pain and symptoms or physical symmetry primarily shape psychological readiness.”
- Also stated in: § DISCUSSION · boosted
“Collectively, our results demonstrated that subjective and psychological factors—namely, perceived knee-related QoL, perceived sport-specific function, and kinesiophobia—rather than objective physical performance or pain and symptoms primarily shape psychological readiness after ACLR.”
- Also stated in: § CONCLUSIONS · plain
“Kinesiophobia, knee-related QoL, and perceived sport function primarily shaped psychological readiness to return to sport after ACLR, defining it as a multidimensional construct influenced more by these factors than by objective quadriceps strength or hop symmetry.”
boosteddirect- Asserted: passes — The authors put it forward as true.
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- Also stated in: § DISCUSSION · boosted
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The minimal contribution of quadriceps strength and hop symmetry underscores the limited value of traditional performance metrics for understanding patients’ psychological states during recovery.”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“data from a 2025 network meta-analysis supported that the ACL-RSI outperforms other psychological measures in predicting successful return-to-sport outcomes.18”
What the sources say
- Not checked yetcites [18] Lo CS, Chen KC, Shih JC, Cheng B, Chao WC. 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. 2025;43(20):2404–2417. doi:10.1080/02640414.2025.2534224
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In contrast, the KOOS-Pain/Symptoms, generalized anxiety, and objective performance measures (quadriceps strength and single-legged hop symmetry) explained minimal unique variance, indicating their contributions largely overlapped with other psychological factors.”
hedged- Asserted: passes — The authors put it forward as true.
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In the paper
“Recent meta-analytic evidence has indicated that athletes who return to sport after ACLR demonstrate higher psychological readiness than those who do not.16”
What the sources say
- Not checked — no full text of the sourcecites [16] Xiao M, van Niekerk M, Trivedi NN, et al. 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. Am J Sports Med. 2023;51(10):2774–2783. doi:10.1177/03635465221102420 source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the KOOS-QoL, the KOOS-Sport, and kinesiophobia emerged as the strongest and most consistent predictors of psychological readiness, explaining the largest proportions of overall and unique variance.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“The remaining unexplained variance (∼30%) suggests that other unmeasured psychological factors, such as reinjury-specific anxiety (distinct from the generalized anxiety assessed in this study), confidence in knee performance, or motivation to resume competitive sport, may further shape psychological readiness.”
- Also stated in: § DISCUSSION · hedged
“Finally, although we assessed a range of psychological, subjective, and objective variables, other potentially influential constructs, such as reinjury anxiety, motivation, coping style, or social support, were not included and may have accounted for additional variance.”
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- Also stated in: § DISCUSSION · hedged
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In the paper
“Third, the cross-sectional design precluded conclusions about causality or temporal ordering among predictors of psychological readiness.”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“This suggests that the early explanatory power of generalized anxiety likely reflects shared variance with more injury- and sport-specific psychological factors that become more salient later in recovery.”
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Our results highlighted that, whereas limb symmetry is a common rehabilitation milestone, it may not meaningfully reflect athletes’ psychological readiness during recovery.”
hedged- Asserted: passes — The authors put it forward as true.
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In the paper
“This suggests that pain and symptom reports are intertwined strongly with athletes’ perceptions of function and fear rather than independently influencing psychological readiness.”
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 23
- Probably not a substantial claim. 10
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Both psychological and physical factors have an established role in ACL injury recovery, but their relative and combined contributions to psychological readiness for return to sport remain unclear.36”
What the sources say
- Partly supportedcites [36] Sell TC, Zerega R, King V, et al. Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI) scores over time after anterior cruciate ligament reconstruction: a systematic review with meta-analysis. Sports Med Open. 2024;10(1):49. doi:10.1186/s40798-024-00712-w sourceExperimental — accuracy not yet measured
The Background says return-to-sport decisions after ACL injury should include physical assessments and that psychological factors affect return to sport and reinjury risk. It also says factors affecting psychological readiness need further study, but it does not specifically establish that the relative and combined contributions of physical and psychological factors to readiness remain unclear. No page numbers are available in our copy. (LLM, conf=0.84)
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Clinicians use objective factors such as age, time from injury, and strength symmetry in clinical decision-making for return to sport after ACLR5–11; however, these alone do not fully explain why some athletes do not return to sport despite achieving adequate physical rehabilitation.12–15”
What the sources say
- Partly supportedcites [5] Feller J, Webster KE. Return to sport following anterior cruciate ligament reconstruction. Int Orthop. 2013;37(2):285–290. doi:10.1007/s00264-012-1690-7 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Partly supportedcites [6] Kaeding CC, Pedroza AD, Reinke EK, Huston LJ, Spindler KP; MOON Consortium. Risk factors and predictors of subsequent ACL injury in either knee after ACL reconstruction: prospective analysis of 2488 primary ACL reconstructions from the MOON cohort. Am J Sports Med. 2015;43(7):1583–1590. doi:10.1177/0363546515578836 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
- Partly supportedcites [7] Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. 2016;44(7):1861–1876. doi:10.1177/0363546515621554 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
- Partly supportedcites [8] Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804–808. doi:10.1136/bjsports-2016-096031 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
- Partly supportedcites [9] Meredith SJ, Rauer T, Chmielewski TL, et al.; Panther Symposium ACL Injury Return to Sport Consensus Group. Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. Orthop J Sports Med. 2020;8(6):2325967120930829. doi:10.1177/2325967120930829 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Not matchedcites [10] Webster KE, Feller JA. A research update on the state of play for return to sport after anterior cruciate ligament reconstruction. J Orthop Traumatol. 2019;20(1):10. doi:10.1186/s10195-018-0516-9
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [11] Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport. 2008;9(1):9–15. doi:10.1016/j.ptsp.2007.09.003 source
- Not checked yetcites [12] Faleide AGH, Inderhaug E. It is time to target psychological readiness (or lack of readiness) in return to sports after anterior cruciate ligament tears. J Exp Orthop. 2023;10(1):94. doi:10.1186/s40634-023-00657-1
- Partly supportedcites [13] Kaplan Y, Witvrouw E. When is it safe to return to sport after ACL reconstruction? Reviewing the criteria. Sports Health. 2019;11(4):301–305. doi:10.1177/1941738119846502 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Partly supportedcites [14] Koca F, Stålman A, Vestberg C, Cristiani R, Fältström A. Poorer patient-reported knee function and quality of life, but not activity level, after revision ACL reconstruction compared with primary ACL reconstruction: a matched-pair analysis with a minimum 5-year follow-up. BMC Musculoskelet Disord. 2023;24(1):831. doi:10.1186/s12891-023-06954-1 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“These psychosocial aspects are still underused in return-to-sport decisions3,20–24 despite evidence of their effect.2,25–35”
What the sources say
- Not checked — no full text of the sourcecites [3] Robinson K, Kossman MK. Psychosocial factors on athlete return to sport readiness after anterior cruciate ligament reconstruction: a critically appraised topic. J Sport Rehabil. 2025;34(2):171–176. doi:10.1123/jsr.2024-0034 source
- Not checked — no full text of the sourcecites [20] Mir B, Vivekanantha P, Dhillon S, et al. Fear of reinjury following primary anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2023;31(6):2299–2314. doi:10.1007/s00167-022-07296-6 source
- Not checked yetcites [21] Almeida GPL, Albano TR, Rodrigues CAS, Tavares MLA, de Paula Lima PO. Combining return to sport, psychological readiness, body mass, hamstring strength symmetry, and hamstring/quadriceps ratio increases the risk of a second anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc. 2023;31(11):5087–5095. doi:10.1007/s00167-023-07559-w
- Not checked — no full text of the sourcecites [22] Ross CA, Clifford A, Louw QA. Factors informing fear of reinjury after anterior cruciate ligament reconstruction. Physiother Theory Pract. 2017;33(2):103–114. doi:10.1080/09593985.2016.1271847 source
- Could not verifycites [23] van Lankveld W, van Melick N, Habets B, Roelofsen E, Staal JB, van Cingel R. Measuring individual hierarchy of anxiety invoking sports related activities: development and validation of the Photographic Series of Sports Activities for Anterior Cruciate Ligament Reconstruction (PHOSA-ACLR). BMC Musculoskelet Disord. 2017;18(1):287. doi:10.1186/s12891-017-1643-9 sourceExperimental — accuracy not yet measured
The Background says psychological factors influence return to sport after ACL reconstruction, and the Discussion recommends that clinicians recognise and address them. Neither passage says these factors are underused in return-to-sport decisions. Searches for underuse and for how often psychological factors are considered in such decisions found no supporting passage in our copy. (LLM, conf=0.70)
- Supportedcites [24] Zarzycki R, Cummer K, Arhos E, et al. Female athletes with better psychological readiness are at higher risk for second ACL injury after primary ACL reconstruction. Sports Health. 2024;16(1):149–154. doi:10.1177/19417381231155120 source
This source supports the clause about evidence of psychosocial factors’ effect, not the separate claim that they are underused in return-to-sport decisions. Its Results report that female athletes who sustained a second ACL injury had significantly higher psychological-readiness and risk-appraisal scores; its clinical recommendations say psychological readiness should be considered in return-to-sport decisions. The findings show an association, not a proven causal effect. (LLM, conf=0.89)
- Not checked — no full text of the sourcecites [2] Hopper HM, Bruce Leicht AS, Thompson XD, et al. The effect of factors from different time points on psychological readiness following ACL reconstruction. Phys Ther Sport. 2024;67:161–166. doi:10.1016/j.ptsp.2024.05.002 source
- Supportedcites [25] Aizawa J, Hirohata K, Ohji S, Ohmi T, Koga H, Yagishita K. Factors associated with psychological readiness to return to sports with cutting, pivoting, and jump-landings after primary ACL reconstruction. Orthop J Sports Med. 2020;8(11):2325967120964484. doi:10.1177/2325967120964484 source
This source is cited for evidence of psychosocial aspects’ effect, not for the separate assertion that they are underused in return-to-sport decisions. The introductory passage in our copy says psychological readiness contributes to return to sport after ACL reconstruction and that readiness scores are related to whether athletes return to their preinjury sport. (LLM, conf=0.89)
- Not checked — no full text of the sourcecites [26] Baez SE, Hoch JM, Cormier M. The Stress and Injury Model and Cognitive Appraisal Model: implications for patients after anterior cruciate ligament reconstruction. Athl Train Sports Health Care. 2020;12(4):181–187. doi:10.3928/19425864-20190924-02 source
- Partly supportedcites [27] Cheng AL, Downs DL, Brady BK, et al. Interpretation of PROMIS depression and anxiety measures compared with DSM-5 diagnostic criteria in musculoskeletal patients. JBJS Open Access. 2023;8(1):e22.00110. doi:10.2106/JBJS.OA.22.00110 sourceExperimental — accuracy not yet measured
The introductory passage following Level of Evidence (page not provided) says that depression and anxiety affect orthopaedic outcomes and that mental-health screening is not yet standard musculoskeletal care. It does not address whether psychosocial factors are underused specifically in return-to-sport decisions. (LLM, conf=0.84)
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Objective functional measures did not meaningfully improve model performance (quadriceps strength symmetry = −0.6%, single-legged hop symmetry = 0.6%).”
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“overall variance decomposition revealed that the KOOS-QoL (18.8%), the KOOS-Sport (14.8%), and kinesiophobia (13.3%) were the strongest contributors to psychological readiness, followed by the KOOS-Pain/Symptoms (9.3%), hop-distance symmetry (5.2%), and generalized anxiety (5.0%).”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The overall model accounted for 70.5% of total variance in ACL-RSI scores (adjusted R2 = 0.64, P < .001), with a cross-validated R2 of 0.61 supporting model stability and minimal overfitting.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The largest unique contributors were the KOOS-Sport (4.9%), kinesiophobia (3.6%), and the KOOS-QoL (3.3%), with all other predictors explaining <1.5% of additional variance.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Notably, the KOOS-Pain/Symptoms contributed to the overall explained variance (9.3%) but demonstrated no meaningful unique contribution after we considered psychological and perceived function variables.”
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Importantly, cross-validation analyses yielded comparable performance estimates, supporting model stability and minimizing concerns about overfitting.”
plainn = 58- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“We assessed the primary outcome of psychological readiness for return to sport using the ACL-RSI scale.17”
What the sources say
- Not matchedcites [17] Webster KE, Feller JA. Development and validation of a short version of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale. Orthop J Sports Med. 2018;6(4):2325967118763763. doi:10.1177/2325967118763763
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In contrast, unique (semipartial) effects were smaller, indicating substantial shared variance among psychological and patient-reported factors.”
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Given that the KOOS-Pain and KOOS-Symptoms were highly correlated (r = 0.86), we averaged results to form a composite indicator, KOOS-Pain/Symptoms, representing perceived knee symptoms and discomfort. This approach minimized multicollinearity while preserving the shared construct of symptomatic knee status.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“with a cross-validated R2 of 0.61 supporting model stability and minimal overfitting.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“To assess model stability and potential overfitting, we conducted repeated 10-fold, cross-validation (50 repeats) and reported the cross-validated R2 as an index of generalizability.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“In previous work, researchers often examined these domains in isolation, which limits clinical insight into how subjective perceptions, psychological variables, and objective measures of function interact during recovery.16,20”
What the sources say
- Not checked — no full text of the sourcecites [16] Xiao M, van Niekerk M, Trivedi NN, et al. 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. Am J Sports Med. 2023;51(10):2774–2783. doi:10.1177/03635465221102420 source
- Not checked — no full text of the sourcecites [20] Mir B, Vivekanantha P, Dhillon S, et al. Fear of reinjury following primary anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2023;31(6):2299–2314. doi:10.1007/s00167-022-07296-6 source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Second, the relatively modest sample size (n = 58) reduced statistical power and limited the ability to detect smaller but clinically meaningful effects.”
plaindirectn = 58- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Additionally, given the number of predictors considered, the subject-to-variable ratio was modest; however, predictors were entered hierarchically based on conceptual domains rather than simultaneously reducing model complexity at each step.”
plaindirectn = 58- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We assessed model assumptions using standard residual diagnostics for linearity, homoscedasticity, and normality.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“First, we collected data from a single clinical site, which may limit generalizability to broader ACLR populations with different rehabilitation practices, demographics, or competitive sport demands.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our results highlighted that readiness reflects how athletes think about and perceive their recovery, not simply how they perform on physical tests.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Generalized anxiety initially explained a notable share of variance in ACL-RSI scores (18.1%), highlighting its importance in early hierarchical models. However, when all predictors were considered together through variance decomposition (Lindeman, Merenda, and Gold method and semipartial R2), the influence of the variable was reduced markedly.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“In the current literature, <65% of athletes who undergo ACLR return to their previous competitive level, with psychological factors, especially fear of reinjury, representing key barriers.4”
What the sources say
- Not checked — no full text of the sourcecites [4] Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011;45(7):596–606. doi:10.1136/bjsm.2010.076364 source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“For our analysis, we used data from each participant’s first visit when the return-to-sport readiness assessment was administered to ensure consistency and minimize potential bias from repeated measures.”
plainn = 58- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Accordingly, the relatively large contributions from generalized anxiety, kinesiophobia, the KOOS-QoL, and the KOOS-Sport appear robust, whereas the smaller ΔR2 values for the KOOS-Pain/Symptoms and objective measures should be interpreted cautiously, as they may reflect limited power rather than true absence of association.”
hedgedcorrelationaln = 58- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Although the modest sample size limited sensitivity to small effects (ΔR2 < 0.05), the study was better positioned to detect moderate-to-large incremental effects.”
plainn = 58- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Inspection of the residuals-versus-fitted diagnostic plot of the overall model (including all predictors) indicated no severe violations of linearity or homoscedasticity. The Q-Q plot showed residuals with approximately normal distribution, which was supported by the Shapiro-Wilk test (W = 0.96, P = .06), indicating no deviation from normality.”
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We evaluated multicollinearity using variance inflation factors (VIFs) for the full regression model (including all predictors), with a VIF of <5 indicating acceptable collinearity.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Some unexplained variance also may reflect measurement error or random variability; however, the use of established measures with supporting validity evidence and stable cross-validation results suggest it is unlikely to be attributable solely to error and likely reflects meaningful unmeasured factors, with effects that may be conservative.”
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All VIF values were <3, indicating acceptable levels of collinearity.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
Citations
Cites
Roos, E. M., Roos, H. P., Lohmander, S. L., Ekdahl, C. S., & Beynnon, B. D. (1998) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.1998.28.2.88 · Cited by 3,989
Pilkonis, P. A., Choi, S. W., Reise, S. P., Stover, A. M., Riley, W. T., Cella, D., & PROMIS Cooperative Group (2011) · Assessment · doi:10.1177/1073191111411667 · Cited by 2,132
Wiggins, A. J., Grandhi, R. K., Schneider, D. K., Stanfield, D., Webster, K. E., & Myer, G. D. (2016) · The American Journal of Sports Medicine · doi:10.1177/0363546515621554 · Cited by 1,429
Self-citationArdern, C. L., Webster, K. E., Taylor, N. F., & Feller, J. A. (2011) · British Journal of Sports Medicine · doi:10.1136/bjsm.2010.076364 · Cited by 1,383
Grindem, H., Snyder-Mackler, L., Moksnes, H., Engebretsen, L., & Risberg, M. A. (2016) · British Journal of Sports Medicine · doi:10.1136/bjsports-2016-096031 · Cited by 1,313
The dominance analysis approach for comparing predictors in multiple regression.
Azen, R., & Budescu, D. V. (2003) · Psychological Methods · doi:10.1037/1082-989x.8.2.129 · Cited by 1,095
Psychometric properties of the TSK-11: A shortened version of the Tampa Scale for Kinesiophobia
Woby, S. R., Roach, N. K., Urmston, M., & Watson, P. J. (2005) · Pain · doi:10.1016/j.pain.2005.05.029 · Cited by 923
Webster, K. E., Feller, J. A., & Lambros, C. (2008) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2007.09.003 · Cited by 823
Kaeding, C. C., Pedroza, A. D., Reinke, E. K., Huston, L. J., MOON Consortium, Spindler, K. P., Amendola, A., Andrish, J. T., Brophy, R. H., Dunn, W. R., et al. (2015) · The American Journal of Sports Medicine · doi:10.1177/0363546515578836 · Cited by 628
Langford, J. L., Webster, K. E., & Feller, J. A. (2009) · British Journal of Sports Medicine · doi:10.1136/bjsm.2007.044818 · Cited by 380
Cited by
Still being checked.
Metadata
- Authors
- Murphy, T., Lyons, L., Mertz-Bynum, N., Lugin, A., Harkey, M. S., Kuenze, C., Baez, S., Myer, G. D., Diekfuss, J., & Petushek, E.
- Affiliations
- Michigan State University (US)
- Michigan Technological University (US)
- University of Virginia (US)
- University of North Carolina at Chapel Hill (US)
- Georgia Institute of Technology (US)
- Emory University (US)
- ORCID
- Venue
- Journal of Athletic Training
- Published
- 2026-10
- Volume
- 61
- Issue
- 10
- Pages
- 668-674
- ISSN
- 1062-6050 (ISSN-L)
- 1938-162X
- OpenAlex
- W7165025947
- Semantic Scholar
- 32fe8901b1149ed287da0988390aa4f7c420b232
- Cited by
- 0
- References
- 44
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Journal of Athletic Training (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Digital Commons - Michigan Tech (Michigan Technological University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
- Social Sciences › Psychology › Developmental and Educational Psychology › Sport Psychology and Performance
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Keywords
- anterior cruciate ligament reconstruction, return to sport, psychological readiness, kinesiophobia, generalized anxiety disorder, quadriceps strength, ACL-RSI scale, biopsychosocial model
- MeSH terms
- Return to Sport, Anterior Cruciate Ligament Injuries, Patient Reported Outcome Measures, Kinesiophobia, Adolescent, Adult, Anxiety, Cross-Sectional Studies, Female, Humans, Male, Quality of Life, 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.
What counts as a claim ›How we measure confidence ›How we check this ›
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