Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 12, pp 3682–3689 | Cite as

Greater fear of reinjury is related to stiffened jump-landing biomechanics and muscle activation in women after ACL reconstruction

  • Stephanie M. Trigsted
  • Dane B. Cook
  • Kristen A. Pickett
  • Lisa Cadmus-Bertram
  • Warren R. Dunn
  • David R. Bell



Fear of reinjury is an important factor in determining who returns to sport following anterior cruciate ligament reconstruction (ACLR). Evidence from other musculoskeletal injuries indicates fear of reinjury may be related to stiffened movement patterns observed in individuals following ACLR. The relationship between fear of reinjury and performance on dynamic tasks, however, has not been investigated. Therefore, the purpose of this study was to investigate the relationship between fear of reinjury and jump-landing biomechanics.


Thirty-six females (height = 168.7 ± 6.5 cm, body mass = 67.2 ± 10.0 kg, age = 18.9 ± 1.5 years) with a history of ACLR (time from surgery = 26.1 ± 13.3 months) participated in the study. Each participant performed five trials of a standard jump-landing task. 3D motion capture and surface electromyography was used to record peak kinematics and lower extremity muscle activation on the injured limb during the jump landings. Spearman’s rank correlations established the relationship between TSK-11 scores and each biomechanical variable of interest.


There was a significant, negative relationship between fear of reinjury (TSK-11: 19.9 ± 4.5) and knee (p = 0.006), hip (p = 0.003), and trunk flexion (p = 0.013). There was also a significant, positive relationship between hip adduction (p = 0.007), and gluteus maximus preparatory activation (p = 0.001).


The results of this study indicate that higher fear of reinjury is associated with stiffened movement patterns that are associated with increased risk of a second ACL injury. Similar movement patterns have been observed in patients with low back pain. Clinicians should evaluate psychological and emotional consequences of injury in addition to the physical consequences as they appear to be related.

Level of evidence



TSK-11 Fear avoidance Jump landing Kinesiophobia 



Funding was provided by Great Lakes Athletic Trainers Association (Grant no. MSN192103).

Compliance with Ethical Standards

Conflict of interest

The author declares tht they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study informed consent is not required.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.High Point UniversityHigh PointUSA
  2. 2.University of Wisconsin MadisonMadisonUSA
  3. 3.Sports Medicine ReedsburgReedsburgUSA

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