2012 Excellence in Research Award

Presented to Brian Noehren for Axial loading rates during walking and running in females with anterior cruciate ligament reconstruction and health controls


2011 Excellence in Research Award

Fear of Re-injury/Low Confidence 1 Year after ACL Reconstruction: High Prevalence and Altered Self-ratings

Trevor Lentz, PT; Giorgio Zeppieri, Jr., PT; Michael W. Moser, MD; Peter A. Indelicato, MD; Steven Z. George, PT, PhD; and Terese L. Chmielewski, PT, PhD


Purpose/Hypothesis: Over of half of the anterior cruciate ligament reconstruction (ACLR) population does not return to pre-injury sports participation. Fear of re-injury/low confidence can be underlying reasons. The purpose of this study was to 1) quantify the prevalence of fear of re-injury/low confidence at 1 year post-ACLR, and 2) compare ratings of pain-related fear of re-injury, knee function and quality of life (QOL) between those that return to sport, those that do not due to fear of re-injury/low-confidence, and those that do not for other reasons. We hypothesized that fear of re­injury/low-confidence would be prevalent and lead to altered self-ratings.

Number of Subjects: 97 subjects with ACLR (58 males; mean age = 24 yrs; mean time from surgery = 12 mo)

Materials/Methods: Subjects were divided into "Return to Sport" (RTS) or "Not Return to Sport" (NRTS) groups based on the answer to "Have you returned to the same level of sports or recreational activities as before your injury?" Subjects in NRTS selected the top 2 reasons prohibiting sports participation (pain, swelling, fear of injury/ lack of confidence, knee instability, muscle weakness, not yet cleared by doctor to return to sport, too little time to participate/change in lifestyle, or other). Subjects selecting fear of injury/lack of confidence as a reason were sub­categorized as NRTS-F. Subjects that selected other reasons were sub-categorized as NRTS-O. All subjects also completed questionnaires on pain-related fear of re-injury (Tampa Scale for Kinesiophobia, TSK-11), knee function (International Knee Documentation Committee Subjective form, IKDC) and QOL (Medical Outcomes Survey Short Form-8, SF-8). Return to sport group differences in TSK-11, IKDC and SF-8 subscale scores were examined with ANOVA and Bonferonni post-hoc testing.

Results: Forty-eight subjects (49%) reported NRTS, and 24 subjects (50% of NRTS) were assigned to NRTS-F. Overall group differences were found in TSK-11, IKDC and SF-8 physical component scores (p<0.01 for all), but not SF-8 mental component scores (p=.65). TSK-11 scores were significantly higher in NRTS-F than RTS (p=.001) and NRTS-O (p=.042). IKDC scores were not different for NRTS-F and NRTS-O (p=.204), but both were lower compared to RTS (p<0.001). SF-8 physical component scores were lower in NRTS-F than in RTS (p=.001), but not different between NRTS groups (p=.345).

Conclusions: Half of those reporting NRTS at 1 year cite fear of re-injury/lack of confidence as a reason. These individuals have higher fear of re-injury and lower knee function and physical QOL than those reporting RTS. They also have higher pain-related fear of re-injury, but similar levels of function and physical QOL compared than those reporting NRTS for other reasons.

Clinical Relevance: Fear of re-injury/lack of confidence is a prevalent reason for NRTS not routinely addressed after ACLR. The TSK-11 has potential to identify those at risk for NRTS due to fear of injury/lack of confidence. Addressing this psychological impairment may promote improved function, QOL, and RTS rates following ACLR.