The Effectiveness of Psychological Interventions for Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Meta-Analysis and Systematic Review.

Background

No systematic review has yet been conducted simultaneously on the effectiveness of psychological interventions across multiple outcome measures during rehabilitation following anterior cruciate ligament reconstruction (ACLR). This study aims to assess the effects of such interventions on pain, psychological outcomes, patient-reported knee function, objective knee measures, and quality of life following ACLR.

Methods

We searched PubMed, Medline, Embase, PsycINFO, and the Cochrane Library from inception to 20 April 2026 (PROSPERO CRD42023483889). Eligible randomized controlled trials compared psychological interventions with usual care in ACLR patients. Two reviewers assessed eligibility, risk of bias, and extracted data. Random-effects models were used; effect sizes were interpreted using Cohen's guidelines.

Results

Of 401 records screened, 11 RCTs (440 participants) were included. Psychological interventions significantly improved pain (six trials, SMD = -0.96, 95% CI -1.40 to -0.52, p < 0.001, I2 = 47%; large effect), kinesiophobia (TSK-11: five trials, SMD = -0.48, -0.74 to -0.22, I2 = 0%; small effect), knee self-efficacy (K-SES: three trials, SMD = 0.53, 0.19-0.86, I2 = 0%, moderate effect), patient-reported knee function (IKDC: two trials, SMD = 0.58, 0.26-0.90, I2 = 0%, moderate effect), and physical role function (SF-36: two trials, SMD = 0.41, 0.04-0.78, I2 = 0%, small effect). No significant effects were found for KT1000, knee strength, SF-36 mental well-being, or ACL-RSI (all p > 0.05, with substantial heterogeneity for ACL-RSI). Particularly, imagery therapy reduced pain (three trials, SMD = -1.54, I2 = 15%).

Conclusions

This meta-analysis provides preliminary evidence that psychological interventions, especially imagery therapy, may improve pain, psychological outcomes, patient-reported knee function, and quality of life after ACLR. Adequately powered trials with standardized protocols are needed to confirm these findings.