Psychological responses and rehabilitation outcomes following anterior cruciate ligament reconstruction surgery

Abstract

Theories of return to play following sports injury prescribe a multidimensional approach (Creighton et al., 2010) to determining when athletes are ready to resume participation, such as following anterior cruciate ligament (ACL) surgery and rehabilitation. Theories and evidence on psychological responses to injury show that cognitions such as knee self-efficacy and perceived recovery, affects such as fear of re-injury and depression/anxiety, and behaviors such as rehabilitation adherence are among the multidimensional factors predictive of return to play outcomes following ACL injuries (te Weirke et al., 2013). It is necessary for researchers to evaluate dynamic patterns of specific psychological responses across the time course of ACL rehabilitation in order to understand how they relate to outcomes such as return to play and perceived disablement. Therefore, the purposes of this study were twofold: (a) to determine if psychological responses to ACL injuries during the latter stages of rehabilitation were different between athletes that returned to play by nine months post-ACL surgery and those who did not, and (b) to assess if psychological responses at 4- and 6-months predicted perceived disablement at 9-months post-surgery. Participants (15 males, 17 females) were physically active individuals who had experienced ACL tears. Psychological measures repeated at 4-, 6-, and 9-months included knee self-efficacy, perceived percent recovery, perceived limitations to ability, mental health, and fear of re-injury. Outcome measures of perceived disablement and return to play status were completed at 9-months post-surgery. For the first purpose, analyses revealed that returners and non-returners differed on fear of re-injury at the 9-month assessment but not at 4- and 6-months post-surgery. Returners having lower levels of fear of re-injury than non-returners at 9-months post-surgery. Returners also reporter higher levels of perceived recovery and lower perceived limitations to ability across ACL rehabilitation. For the second purpose, none of the psychological measures at 4-months post-surgery predicted 9-month disablement, while at 6-months perceived percent recovery inversely predicted disablement at 9-months post-surgery. Results reveal that psychological responses are important in determining rehabilitation outcomes post-ACL surgery.