Knee-Related Function and Psychological Aspects After ACL Reconstruction Among Individuals With and Without Kinesiophobia: A Mixed-Methods Study.

BACKGROUND

Kinesiophobia is known to lead to a poor rate of return to sports despite following a rigorous rehabilitation protocol following anterior cruciate ligament reconstruction (ACLR).

PURPOSE: This study aimed to describe the perspectives on rehabilitation and recovery in patients with ACLR categorized as having high or low kinesiophobia in relation to activity, function, and psychological status.

STUDY

DESIGN

Mixed methods.

METHODS

Participants with primary ACLR (5-12 months postoperative) were recruited and divided into high and low kinesiophobia groups based on the Tampa Scale of Kinesiophobia-11 scores. Participants completed the Tegner activity scale, Marx activity scale, International Knee Documentation Committee, the Knee Injury and Osteoarthritis Outcome Scale (KOOS), the Anterior Cruciate Ligament Return to Sports after Injury scale, and the Generalized Anxiety Disorder-7; and participated in individual semi-structured interviews. Interview data were qualitatively analyzed using the general inductive approach. . Differences in outcomes of the PROs were analyzed using the Mann-Whitney test (p<0.05).

RESULTS

Nine participants with high kinesiophobia (age= 22.2 (3.1) years), five women) and low kinesiophobia groups (n = 6, age=25.5 (3.4) years, four women) were recruited. Participants in both the high and low kinesiophobia groups reported behaviors related to these themes: fear of re-injury, activity avoidance and interlimb asymmetry, and coping mechanisms. Significant differences were found between KOOS quality of life scores between groups (High kinesiophobia group= 56.3 [37.5 -81.3], low kinesiophobia group= 71.9 [62.5-75.0] p= 0.012). No statistical differences were found in any other outcome measures.

CONCLUSIONS

Patients with primary ACLR report psychological, biomechanical, and other behavioral changes that may negatively impact recovery. Significantly lower quality of life scores among participants with high kinesiophobia suggest that fear of movement may have a particularly detrimental impact on perceived recovery outcomes. These findings highlight the importance of assessing psychological factors alongside physical recovery measures in patients following ACLR, which may inform more comprehensive rehabilitation approaches.

LEVEL OF EVIDENCE: Level 3b; Qualitative= NA.