Comparison of Physical Impairment, Functional, and Psychosocial Measures Based on Fear of Reinjury/Lack of Confidence and Return-to-Sport Status After ACL Reconstruction.

Background: Fear of reinjury and lack of confidence influence return-to-sport outcomes after anterior cruciate ligament (ACL)reconstruction. The physical, psychosocial, and functional recovery of patients reporting fear of reinjury or lack of confidenceas their primary barrier to resuming sports participation is unknown.Purpose: To compare physical impairment, functional, and psychosocial measures between subgroups based on return-to-sportstatus and fear of reinjury/lack of confidence in the return-to-sport stage and to determine the association of physical impairmentand psychosocial measures with function for each subgroup at 6 months and 1 year after surgery.Study Design: Case-control study; Level of evidence, 3.Methods: Physical impairment (quadriceps index [QI], quadriceps strength/body weight [QSBW], hamstring:quadriceps strengthratio [HQ ratio], pain intensity), self-report of function (International Knee Documentation Committee [IKDC]), and psychosocial(Tampa Scale for Kinesiophobia–shortened form [TSK-11]) measures were collected at 6 months and 1 year after surgery in73 patients with ACL reconstruction. At 1 year, subjects were divided into ‘‘return-to-sport'' (YRTS) or ‘‘not return-to-sport''(NRTS) subgroups based on their self-reported return to preinjury sport status. Patients in the NRTS subgroup were subcategorizedas NRTS-Fear/Confidence if fear of reinjury/lack of confidence was the primary reason for not returning to sports, and allothers were categorized as NRTS-Other.Results: A total of 46 subjects were assigned to YRTS, 13 to NRTS-Other, and 14 to NRTS-Fear/Confidence. Compared with theYRTS subgroup, the NRTS-Fear/Confidence subgroup was older and had lower QSBW, lower IKDC score, and higher TSK-11score at 6 months and 1 year; however, they had similar pain levels. In the NRTS-Fear/Confidence subgroup, the IKDC scorewas associated with QSBW and pain at 6 months and QSBW, QI, pain, and TSK-11 scores at 1 year.Conclusion: Elevated pain-related fear of movement/reinjury, quadriceps weakness, and reduced IKDC score distinguishpatients who are unable to return to preinjury sports participation because of fear of reinjury/lack of confidence. Despite low averagepain ratings, fear of pain may influence function in this subgroup. Assessment of fear of reinjury, quadriceps strength, andself-reported function at 6 months may help identify patients at risk for not returning to sports at 1 year and should be consideredfor inclusion in return-to-sport guidelines. [ABSTRACT FROM AUTHOR]