Psychosocial factors that affect return to sports after anterior cruciate ligament reconstruction

Abstract

Despite successful surgical results and adequate rehabilitation processes, the proportion of individuals who can reach pre-injury sportive levels after anterior cruciate ligament repair is lower than expected. Given that successful functional outcomes are not equivalent to a successful return to sport, it is important to describe any underlying factors other than physical function that may contribute to these low return rates. The importance of psychosocial factors in this regard is increasingly gain importance. This study aims to review the available evidence of psychosocial factors that affect return to sports after anterior cruciate ligament repair in the literature. It is thought that better understanding of psychosocial factors and integrating this knowledge into rehabilitation protocols would increase the rate of return to sports succesfully in the future.

Keywords

• anterior cruciate ligament
• reconstruction
• rehabilitation
• psychosocial factors
• biopsychosocial model
• ön çapraz bağ tamiri
• rehabilitasyon
• psikososyal faktörler
• biyopsikososyal model

Ön çapraz bağ tamiri sonrası spora dönüşü etkileyen psikososyal faktörler

Abstract

Başarılı cerrahi sonuçlar ve yeterli rehabilitasyona rağmen ön çapraz bağ tamiri sonrasında yaralanma öncesi sportif düzeylerine ulaşabilen bireylerin oranı beklenenden düşüktür. Başarılı fiziksel fonksiyon sonuçlarının spora başarılı bir dönüşle eşdeğer olmadığı düşünüldüğünde, bu düşük geri dönüş oranlarına katkıda bulunabilecek fiziksel fonksiyon dışında altta yatan faktörleri ele almak önemlidir. Literatürde psikososyal faktörlerin önemi giderek daha fazla artmaktadır. Bu çalışma ön çapraz bağ tamiri sonrası spora dönüşü etkileyen psikososyal faktörlerin literatürdeki mevcut kanıtlarını derlemeyi amaçlamaktadır. Psikososyal faktörlerin daha iyi anlaşılması ve bu bilgilerimizin rehabilitasyon protokollerine entegre edilmesinin spora başarılı dönüş oranlarını arttıracağı düşünülmektedir.

Keywords

• ön çapraz bağ tamiri
• rehabilitasyon
• psikososyal faktörler
• biyopsikososyal model

References

1. 1. Nwachukwu BU, Voleti PB, Berkanish P, Chang B, Cohn MR, Williams III RJ, et al. Return to play and patient satisfaction after ACL reconstruction: study with minimum 2-year follow-up. JBJS. 2017;99(9):720-5.
2. 2. Shea KG, Carey JL. Management of anterior cruciate ligament injuries: evidencebased guideline. JAAOS. 2015;23(5):e1-e5.
3. 3. Kim S, Bosque J, Meehan JP, Jamali A, Marder R. Increase in outpatient knee arthroscopy in the United States: a comparison of national surveys of ambulatory surgery, 1996 and 2006. J Bone Joint Surg Am. 2011;93(11):994-1000.
4. 4. Webster KE, Feller JA. Expectations for return to preinjury sport before and after anterior cruciate ligament reconstruction. Am J Sports Med. 2019;47(3):578-83.
5. 5. Ardern CL, Taylor NF, Feller JA, Webster KE. 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. 2014;48(21):1543-52.
6. 6. Nwachukwu BU, Adjei J, Rauck RC, Chahla J, Okoroha KR, Verma NN, et al. How much do psychological factors affect lack of return to play after anterior cruciate ligament reconstruction? A systematic review. Orthop J Sports Med. 2019;7(5):2325967119845313.
7. 7. Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. 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. 2015;43(4):848-56.
8. 8. Burland JP, Toonstra JL, Howard JS. Psychosocial barriers after anterior cruciate ligament reconstruction: A clinical review of factors ınfluencing postoperative success. Sports Health. 2019;11(6):528-34.

9. 9. Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2013;41(7):1549-58.
10. 10. Ashton ML, Kraeutler MJ, Brown SM, Mulcahey MK. Psychological readiness to return to sport following anterior cruciate ligament reconstruction. JBJS Reviews. 2020;8(3):e0110.
11. 11. Di Stasi SL, Logerstedt D, Gardinier ES, Snyder-Mackler L. Gait patterns differ between ACL-reconstructed athletes who pass return-to-sport criteria and those who fail. Am J Sports Med. 2013;41(6):1310-8.
12. 12. Everhart JS, Best TM, Flanigan DC. Psychological predictors of anterior cruciate ligament reconstruction outcomes: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2015;23(3):752-62.
13. 13. Tjong VK, Murnaghan ML, Nyhof-Young JM, Ogilvie-Harris DJ. A qualitative investigation of the decision to return to sport after anterior cruciate ligament reconstruction: to play or not to play. Am J Sports Med. 2014;42(2):336-42.
14. 14. Te Wierike S, Van Der Sluis A, van den Akker‐Scheek I, Elferink‐Gemser M, Visscher C. Psychosocial factors influencing the recovery of athletes with anterior cruciate ligament injury: a systematic review. Scand J Med Sci Sports. 2013;23(5):527-40.
15. 15. Thomeé P, Währborg P, Börjesson M, Thomeé R, Eriksson B, Karlsson J. Selfefficacy of knee function as a pre-operative predictor of outcome 1 year after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2008;16(2):118-27.
16. 16. Ardern CL, Österberg A, Sonesson S, Gauffin H, Webster KE, Kvist J. Satisfaction with knee function after primary anterior cruciate ligament reconstruction is associated with self-efficacy, quality of life, and returning to the preinjury physical activity. Arthroscopy. 2016;32(8):1631-8. e3.
17. 17. Brand E, Nyland J. Patient outcomes following anterior cruciate ligament reconstruction: the influence of psychological factors. Orthopedics. 2009;32(5):335.
18. 18. Garcia GH, Wu H-H, Park MJ, Tjoumakaris FP, Tucker BS, Kelly IV JD, et al. Depression symptomatology and anterior cruciate ligament injury: incidence and effect on functional outcome—a prospective cohort study. Am. J. Sports Med. 2016;44(3):572-9.
19. 19. Swirtun L, Renström P. Factors affecting outcome after anterior cruciate ligament injury: a prospective study with a six-year followup. Scand J Med Sci Sports. 2008;18(3):318-24.
20. 20. Brewer BW, Van Raalte JL, Cornelius AE, Petitpas AJ, Sklar JH, Pohlman MH, et al. Psychological factors, rehabilitation adherence, and rehabilitation outcome after anterior cruciate ligament reconstruction. Rehabil. Psychol. 2000;45(1):20.
21. 21. Carson F, Polman R. The facilitative nature of avoidance coping within sports injury rehabilitation. Scand J Med Sci Sports. 2010;20(2):235-40.
22. 22. Lepley LK. Deficits in quadriceps strength and patient-oriented outcomes at return to activity after ACL reconstruction: a review of the current literature. Sports Health 2015;7(3):231-8.
23. 23. Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804-8.
24. 24. McPherson AL, Feller JA, Hewett TE, Webster KE. Psychological readiness to return to sport is associated with second anterior cruciate ligament injuries. Am J Sports Med. 2019;47(4):857-62.