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INTRODUCTION
Following anterior cruciate ligament (ACL)
reconstruction, there are many factors that
influence an individual’s ability, desire and
decision whether to return to sport and at what
level. It is recognised that there is a poor
correlation between objective knee function
and return to sport following ACL re
construction [5]. This suggests that there are
other factors that may play a role and these may
include lifestyle, occupational concerns and
psychological factors.
Negative psychological responses have been
associated with sports injury and may persist
following surgery and rehabilitation. They may
continue to be present even when an athlete
receives clearance to return to sports. Such
negative responses include tension, low self-
esteem, depression and anxiety. The athlete’s
ability to cope with stress may also influence
their recovery and rehabilitation.
FEAR OF RE-INJURY
Fear of re-injury may affect an athlete’s ability
to return to their previous sports and may also
affect the quality of their performance when
participating in sport. Using the Tampa Scale
of Kinesiophobia, Kvist
et al.
identified fear of
re-injury as a significant factor in patients who
did not return to their pre-injury activity level
compared to those who did [7]. Exactly what
constitutes fear of re-injury is unclear. It may
be the fear of the pain of injury itself, fear of
the subsequent surgery, fear of the rehabilitation
process and time out of sport, fear of the
implications for time off work and income, or a
combination of the above.
Ardern
et al.
[1] investigated whether fear of
re-injury was still a consideration in athletes
who made a successful return to their sport.
A cohort of 209 athletes answered a series
of questions regarding the behavioural
manifestations of fear, such as playing with
hesitation and being wary of injury provoking
situations. Overall, the results showed that
athletes who had successfully returned to their
pre-injury sport generally participated without
fear of re-injury. Males who had earlier surgery
(<3 months after injury) were found to
participate in their pre-injury sport with the
least amount of fear. This was consistent with
previous work which showed that during
rehabilitation males report being more
influenced by powerful others, such as trained
professionals (doctors, physiotherapists) and
team-mates compared with females. This may
be protective against any negative psy
chological impact associated with returning to
sport after this surgery [11].
PSYCHOLOGICAL FACTORS AND
ANTERIOR CRUCIATE LIGAMENT
RECONSTRUCTION
J.A. FELLER, K.E. WEBSTER