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Fear of reinjury following primary anterior cruciate ligament reconstruction: a systematic review

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This review aims to elucidate the most commonly reported method to quantify fear of reinjury or kinesiophobia and to identify key variables that influence the degree of kinesiophobia following primary anterior cruciate ligament reconstruction (ACLR).

Methods

A systematic search across three databases (Pubmed, Ovid (MEDLINE), and EMBASE) was conducted from database inception to August 7th, 2022. The authors adhered to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Quality assessment of the included studies was conducted according to the Methodological Index for Non-Randomized Studies (MINORS) criteria.

Results

Twenty-six studies satisfied the inclusion criteria and resulted in 2,213 total patients with a mean age of 27.6 years and a mean follow-up time of 36.7 months post-surgery. The mean MINORS score of the included studies was 11 out of 16 for non-comparative studies and 18 out of 24 for comparative studies. Eighty-eight percent of included studies used variations of the Tampa Scale of Kinesiophobia (TSK) to quantify kinesiophobia and 27.0% used Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI). The results of this study shows a common association between higher kinesiophobia and poor patient-reported functional status measured using International Knee Documentation Committee (IKDC) Scores, Activity of Daily Living (ADL), Quality of Life (QOL), and Sports/Recreation (S/R) subscales of Knee Osteoarthritis and Outcome Score (KOOS) and Lysholm scores. Postoperative symptoms and pain catastrophizing measured using the KOOS pain and symptom subscales and Pain Catastrophizing Score (PCS) also influenced the degree of kinesiophobia following ACLR. Patients with an increased injury to surgery time and being closer to the date of surgery postoperatively demonstrated higher levels of kinesiophobia. Less common variables included being a female patient, low preoperative and postoperative activity status and low self-efficacy.

Conclusion

The most common methods used to report kinesiophobia following primary ACLR were variations of the TSK scale followed by ACL-RSI. The most commonly reported factors influencing higher kinesiophobia in this patient population include lower patient-reported functional status, more severe postoperative symptoms such as pain, increased injury to surgery time, and being closer to the date of surgery postoperatively. Kinesiophobia following primary ACLR is a critical element affecting post-surgical outcomes, and screening should be implemented postoperatively to potentially treat in rehabilitation and recovery.

Level of evidence

IV.

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Abbreviations

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

TSK:

Tampa Scale of Kinesiophobia

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analyses

ACL-RSI:

Anterior Cruciate Ligament Return to Sport After Injury

MINORS:

Methodological Index for Non-Randomized Studies

ICC:

Intra-class correlation coefficient

ICC:

Intra-class correlation coefficient

IKDC:

International Knee Documentation Committee

KOOS-ADL:

Knee Injury and Osteoarthritis Outcome Score Activities of Daily Living

KOOS-QoL:

Knee Injury and Osteoarthritis Outcome Score Quality of Life

KOOS-S/R:

Knee Injury and Osteoarthritis Outcome Score Sports/Recreation

PCS:

Pain Catastrophizing Scale

PFP:

Patellofemoral Pain

SF-8:

Short Form 8

NRS:

Numerical Rating Scale

SER:

Self-Efficacy for Rehabilitation Outcome Scale

K-SES:

Knee-specific self-efficacy scale

OA:

Osteoarthritis

FAM:

Fear avoidance model

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Authors and Affiliations

  1. Ashford and St. Peter’s Hospitals NHS Foundation Trust, Chertsey, Surrey, UK

    Basit Mir

  2. Michael DeGroote School of Medicine, McMaster, Hamilton, ON, Canada

    Prushoth Vivekanantha

  3. Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Saihajleen Dhillon

  4. Faculty of Arts and Science, Queen’s University, Kingston, ON, Canada

    Odette Cotnareanu

  5. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E14, Hamilton, ON, L8N 3Z5, Canada

    Dan Cohen & Darren de SA

  6. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan

    Kanto Nagai

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  3. Saihajleen Dhillon
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Correspondence to Darren de SA.

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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 31, 2299–2314 (2023). https://doi.org/10.1007/s00167-022-07296-6

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