Advertisement

Psychological Factors Influencing Return to Sport After Anterior Cruciate Ligament Reconstruction

  • Kate E WebsterEmail author
  • Julian A Feller
Chapter

Abstract

Despite having good knee function, many athletes do not return to their previous level of preinjury sport following anterior cruciate ligament (ACL) reconstruction. This suggests that there are other factors which influence return to sport after this surgery. Recent reviews and meta-analyses have demonstrated that a range of contextual factors affect the return-to-sport rate after ACL reconstruction including age, sex, sport participation level and psychological factors. In terms of psychological factors, there is convincing evidence that a lower fear of reinjury and greater psychological readiness are associated with higher return-to-sport rates. A number of measurement tools are now available which aim to measure such constructs, one of which is specific to ACL injury, the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale. This scale has shown clear associations between psychological readiness and return to sport, even when used before athletes undergo surgery. Clinical cut-off scores have been proposed, which may guide both the athlete and clinician in the return-to-sport process. This chapter provides a summary of the evidence of the psychological aspects related to injury recovery and returning to sport following ACL reconstruction injury and surgery.

Top Five Evidence Based References

  1. Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE (2013) Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med 41:1549–1558CrossRefPubMedGoogle Scholar
  2. Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE (2013) Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med 41:1549–1558CrossRefPubMedGoogle Scholar
  3. Kvist J, Ek A, Sporrstedt K, Good L (2005) Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 13:393–397CrossRefPubMedGoogle Scholar
  4. Langford JL, Webster KE, Feller JA (2009) A prospective longitudinal study to assess psychological changes following anterior cruciate ligament reconstruction surgery. Br J Sports Med 43:377–381CrossRefPubMedGoogle Scholar
  5. Webster KE, Feller JA, Lambros C (2008) Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport 9:9–15CrossRefPubMedGoogle Scholar

References

  1. 1.
    Ardern CL, Taylor NF, Feller JA, Webster KE (2013) A systematic review of the psychological factors associated with returning to sport following injury. Br J Sports Med 47:1120–1126CrossRefPubMedGoogle Scholar
  2. 2.
    Podlog L, Eklund RC (2010) Returning to competition after a serious injury: the role of self-determination. J Sports Sci 28:819–831CrossRefPubMedGoogle Scholar
  3. 3.
    te Wierike SC, van der Sluis A, van den Akker-Scheek I, Elferink-Gemser MT, Visscher C (2013) Psychosocial factors influencing the recovery of athletes with anterior cruciate ligament injury: a systematic review. Scand J Med Sci Sports 23:527–540Google Scholar
  4. 4.
    Ardern CL, Taylor NF, Feller JA, Webster KE (2012) Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery. Am J Sports Med 40:41–48CrossRefPubMedGoogle Scholar
  5. 5.
    Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 45:596–606CrossRefPubMedGoogle Scholar
  6. 6.
    Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med 39:538–543CrossRefPubMedGoogle Scholar
  7. 7.
    McLean SG, Huang X, van den Bogert AJ (2008) Investigating isolated neuromuscular control contributions to non-contact anterior cruciate ligament injury risk via computer simulation methods. Clin Biomech (Bristol, Avon) 23:926–936CrossRefGoogle Scholar
  8. 8.
    Smith AM (1996) Psychological impact of injuries in athletes. Sports Med 22:391–405CrossRefPubMedGoogle Scholar
  9. 9.
    Smith AM, Scott SG, O'Fallon WM, Young ML (1990) Emotional responses of athletes to injury. Mayo Clin Proc 65:38–50CrossRefPubMedGoogle Scholar
  10. 10.
    Smith AM, Scott SG, Wiese DM (1990) The psychological effects of sports injuries coping. Sports Med 9:352–369CrossRefPubMedGoogle Scholar
  11. 11.
    Morrey MA, Stuart MJ, Smith AM (1999 Apr) Wiese-Bjornstal DM (1999) A longitudinal examination of athletes' emotional and cognitive responses to anterior cruciate ligament injury. Clin J Sport Med 9(2):63–69CrossRefPubMedGoogle Scholar
  12. 12.
    Walker N, Thatcher J, Lavallee D (2007) Psychological responses to injury in competitive sport: a critical review. J R Soc Promot Heal 127:174–180CrossRefGoogle Scholar
  13. 13.
    Ruddock-Hudson M, O'Halloran P, Murphy G (2012) Exploring psychological reactions to injury in the Australian Football League (AFL). J Appl Sport Psychol 24:375–390Google Scholar
  14. 14.
    Kleiber D, Greendorfer S, Blinde E, Samdahl D (1987) Quality of exit from university sports and life satisfaction in early adulthood. Sociol Sport J 4:28–36CrossRefGoogle Scholar
  15. 15.
    Ardern CL, Taylor NF, Feller JA, Webster KE (2014) Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 48:1543–1552CrossRefPubMedGoogle Scholar
  16. 16.
    Czuppon S, Racette BA, Klein SE, Harris-Hayes M (2014) Variables associated with return to sport following anterior cruciate ligament reconstruction: a systematic review. Br J Sports Med 48:356–364CrossRefPubMedGoogle Scholar
  17. 17.
    Everhart JS, Best TM, Flanigan DC (2015) Psychological predictors of anterior cruciate ligament reconstruction outcomes: a systematic review. Knee Surg Sports Traumatol Arthrosc 23:752–762CrossRefPubMedGoogle Scholar
  18. 18.
    Ardern CL, Kvist J, Webster KE (2015) Psychological aspects of anterior cruciate ligament injuries. Operative Tech Sports Med 24:77–83CrossRefGoogle Scholar
  19. 19.
    Brewer B, Andersen MB, van Raalte JL (2002) Psychological aspects of sport injury rehabilitation: toward a biopsychosocial approach. In: Mostofsky D, Zaichkowsky LD (eds) Medical and psychological aspects of sport and exercise. Fitness Information Technology, Morgantown, WV, pp 41–54Google Scholar
  20. 20.
    Wiese-Bjornstal DM, Smith AM, Schaffer SM, Morrey MA (1988) An integrated model of response to sport injury: Psychological and sociological dynamics. J Appl Sport Psychol 10:46–69CrossRefGoogle Scholar
  21. 21.
    Brewer B (2010) The role of psychological factors in sport injury rehabilitation outcomes. Rev Sport Exerc Psychol 3:40–61CrossRefGoogle Scholar
  22. 22.
    Christino MA, Fantry AJ, Vopat BG (2015) Psychological aspects of recovery following anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 23:501–509CrossRefPubMedGoogle Scholar
  23. 23.
    Podlog L, Heil J, Schulte S (2014) Psychosocial factors in sports injury rehabilitation and return to play. Phys Med Rehabil Clin N Am 25:915–930CrossRefPubMedGoogle Scholar
  24. 24.
    Langford JL, Webster KE, Feller JA (2009) A prospective longitudinal study to assess psychological changes following anterior cruciate ligament reconstruction surgery. Br J Sports Med 43:377–381CrossRefPubMedGoogle Scholar
  25. 25.
    Thomeé P, Währborg P, Börjesson M, Thomeé R, Eriksson BI, Karlsson J (2007) Self-efficacy, symptoms and physical activity in patients with an anterior cruciate ligament injury: a prospective study. Scand J Med Sci Sports 17:238–245PubMedGoogle Scholar
  26. 26.
    Nyland J, Cottrell B, Harreld K, Caborn DN (2006) Self-reported outcomes after anterior cruciate ligament reconstruction: an internal health locus of control score comparison. Arthroscopy 22:1225–1232CrossRefPubMedGoogle Scholar
  27. 27.
    Thomeé P, Währborg P, Börjesson M, Thomeé R, Eriksson BI, Karlsson J (2008) Self-efficacy of knee function as a pre-operative predictor of outcome 1 year after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 16:118–127CrossRefPubMedGoogle Scholar
  28. 28.
    Thomeé P, Währborg P, Börjesson M, Thomeé R, Eriksson BI, Karlsson J (2007) Determinants of self-efficacy in the rehabilitation of patients with anterior cruciate ligament injury. J Rehabil Med 39:486–492CrossRefPubMedGoogle Scholar
  29. 29.
    Thomeé P, Währborg P, Börjesson M, Thomeé R, Eriksson BI, Karlsson J (2006) A new instrument for measuring self-efficacy in patients with an anterior cruciate ligament injury. Scand J Med Sci Sports 16:181–187CrossRefPubMedGoogle Scholar
  30. 30.
    Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE (2013) Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med 41:1549–1558CrossRefPubMedGoogle Scholar
  31. 31.
    Sonesson S, Kvist J, Ardern C, Österberg A, Grävare Silbernagel K (2016) Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-016-4294-8
  32. 32.
    Kvist J, Ek A, Sporrstedt K, Good L (2005) Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 13:393–397CrossRefPubMedGoogle Scholar
  33. 33.
    Flanigan DC, Everhart JS, Pedroza A, Smith T, Kaeding CC (2013) Fear of reinjury (kinesiophobia) and persistent knee symptoms are common factors for lack of return to sport after anterior cruciate ligament reconstruction. Arthroscopy 29:1322–1329CrossRefPubMedGoogle Scholar
  34. 34.
    Mann BJ, Grana WA, Indelicato PA, O'Neill DF, George SZ (2007) A survey of sports medicine physicians regarding psychological issues in patient-athletes. Am J Sports Med 35:2140–2147CrossRefPubMedGoogle Scholar
  35. 35.
    Ross CA, Clifford A, Louw QA (2017) Factors informing fear of reinjury after anterior cruciate ligament reconstruction. Physiother Theory Pract 33:103–114CrossRefPubMedGoogle Scholar
  36. 36.
    Walker N, Thatcher J, Lavallee D (2010) A preliminary development of the Re-Injury Anxiety Inventory (RIAI). Phys Ther Sport 11:23–29CrossRefPubMedGoogle Scholar
  37. 37.
    Ardern CL, Taylor NF, Feller JA, Webster KE (2012) Fear of re-injury in people who have returned to sport following anterior cruciate ligament reconstruction surgery. J Sci Med Sport 15:488–495CrossRefPubMedGoogle Scholar
  38. 38.
    Podlog L, Banham SM, Wadey R, Hannon J (2015) Psychological readiness to return to competitive sport following injury: a qualitative study. Sport Psychologist 29:1–14CrossRefGoogle Scholar
  39. 39.
    Webster KE, Feller JA, Lambros C (2008) Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport 9:9–15CrossRefPubMedGoogle Scholar
  40. 40.
    Ardern CL, Österberg A, Tagesson S, Gauffin H, Webster KE, Kvist J (2014) The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. Br J Sports Med 48:1613–1619CrossRefPubMedGoogle Scholar
  41. 41.
    Johnston L, Carroll D (1998) The context of emotional responses to athletic injury: a qualitative analysis. J Sport Rehabil 7:206–220CrossRefGoogle Scholar
  42. 42.
    Quinn AM, Fallon BJ (1999) The changes in psychological characteristics and reactions of elite athletes from injury onset until full recovery. J Appl Sport Psychol 11:210–229CrossRefGoogle Scholar
  43. 43.
    Forsdyke D, Smith A, Jones M, Gledhill A (2016) Psychosocial factors associated with outcomes of sports injury rehabilitation in competitive athletes: a mixed studies systematic review. Br J Sports Med 50:537–544CrossRefPubMedGoogle Scholar
  44. 44.
    Glazer DD (2009) Development and preliminary validation of the Injury-Psychological Readiness to Return to Sport (I-PRRS) scale. J Athl Train 44:185–189CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    French DJ, France CR, Vigneau F, French JA, Evans RT (2007) Fear of movement/(re)injury in chronic pain: a psychometric assessment of the original English version of the Tampa scale for kinesiophobia (TSK). Pain 127:42–51CrossRefPubMedGoogle Scholar
  46. 46.
    Mohtadi N (1998) Development and validation of the quality of life outcome measure (questionnaire) for chronic anterior cruciate ligament deficiency. Am J Sports Med 26:350–359CrossRefPubMedGoogle Scholar
  47. 47.
    Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE (2015) Sports participation 2 years after anterior cruciate ligament reconstruction in athletes who had not returned to sport at 1 year: a prospective follow-up of physical function and psychological factors in 122 athletes. Am J Sports Med 43:848–856CrossRefPubMedGoogle Scholar
  48. 48.
    Müller U, Krüger-Franke M, Schmidt M, Rosemeyer B (2015) Predictive parameters for return to pre-injury level of sport 6 months following anterior cruciate ligament reconstruction surgery. Knee Surg Sports Traumatol Arthrosc 23:3623–3631CrossRefPubMedGoogle Scholar
  49. 49.
    Kvist J, Österberg A, Gauffin H, Tagesson S, Webster K, Ardern C (2013) Translation and measurement properties of the Swedish version of ACL-Return to Sports after Injury questionnaire. Scand J Med Sci Sports 23:568–575PubMedGoogle Scholar
  50. 50.
    Bohu Y, Klouche S, Lefevre N, Webster K, Herman S (2015) Translation, cross-cultural adaptation and validation of the French version of the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale. Knee Surg Sports Traumatol Arthrosc 23:1192–1196CrossRefPubMedGoogle Scholar
  51. 51.
    Müller U, Schmidt M, Krüger-Franke M, Rosemeyer B (2014) Die ACL-Return to Sport after Injury Skala als wichtiger Parameter bei der Beurteilung Rückkehr zum Sport Level I und II nach Rekonstruktion des vorderen Kreuzbands. Ihre Übersetzung in die deutsche Sprache (ACL-Return to Sport after Injury Scale as an important Predictor for Return to Sport Level I and II after ACL Reconstruction. Translation into German Language). Sport Orthop Traumatol 30:135–144CrossRefGoogle Scholar
  52. 52.
    Slagers AJ, Reininga IH, van den Akker-Scheek I (2017) The Dutch language anterior cruciate ligament return to sport after injury scale (ACL-RSI) - validity and reliability. J Sports Sci 35(4):393–401CrossRefPubMedGoogle Scholar
  53. 53.
    Harput G, Tok D, Ulusoy B, Eraslan L, Yildiz TI, Turgut E et al (2016) Translation and cross-cultural adaptation of the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale into Turkish. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-016-4288-6

Copyright information

© ESSKA 2018

Authors and Affiliations

  1. 1.School of Allied HealthLa Trobe UniversityBundooraAustralia
  2. 2.OrthoSport VictoriaEpworth HealthCareRichmondAustralia

Personalised recommendations