Context: Despite positive physical outcomes of anterior cruciate ligament reconstruction (ACLR) many athletes do not return to sport following ACLR.
Objective: To determine if there were differences between athletes who returned to play and those who did not return to sport after ACLR in patterns of psychological responses to injury over the latter course of rehabilitation and return to sport.
Design: Case-control study.
Setting: Comprehensive orthopedic medical center referrals.
Participants: Thirty-nine recreational and competitive athletes (13-58 years, 21 males) with first ACL tear were observed over the course of the study.
Main outcome measure: Return to sport.
Results: Fifty-two percent of participants returned to play by 9-months post-ACLR. Returners showed a linear decrease in re-injury anxiety from 4- to 9-months post-ACLR while non-returners showed a linear decrease from 4- to 6-months post-ACLR and then a leveling off from 6- to 9-months. Returners showed linear and quadratic effects on perceived limitations to ability with a decrease from 4- to 9- months post-ACLR that accelerated over time while non-returners decreased linearly over time. No significant differences were found between returners and non-returners in knee self-efficacy, perceived percent recovery, and psychological distress.
Conclusions: Results suggest re-injury anxiety and perceived limitations to ability are psychological constructs on which returners and non-returners differ and therefore may be points of intervention to increase the likelihood of return to sport.
Keywords: anterior cruciate ligament; fear of re-injury; knee self-efficacy; return to sport.