Effectiveness of psychological intervention following anterior cruciate ligament reconstruction: A systematic review and meta-analysis.

OBJECTIVE: To determine the effectiveness of psychological interventions in postoperative anterior cruciate ligament reconstruction (ACLR) compared to standard rehabilitation. METHODS: The databases searched were PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, PEDro, Cumulative Index to Nursing & Allied Health Literature, and EMBASE were searched from each database inception to May 2023 for published studies. The methodological quality was assessed with the Cochrane Risk of Bias Assessment (RoB 2.0) tool. The evidence quality was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: Six papers were included in the meta-analysis. Psychological intervention significantly improved Tampa Scale for Kinesiophobia at 3 months (Standard Mean Difference [SMD], -0.51. 95% Confidence Interval [CI], -0.85 to -0.17) and pain (Knee Injury and Osteoarthritis Outcome Score for Pain, Numeric Rating Scale, Visual Analog Scale) at 3 months (SMD, -0.92. 95%CI, -1.69 to -0.15) and at 6 months following ACLR (MD, -1.25. 95%CI, -1.82 to -0.68) when compared with the standard rehabilitation, according to very low-quality data. Self-efficacy and knee strength did not show significant differences. CONCLUSION: Very low-quality evidence suggests that psychological intervention following ACLR yields better short-term outcomes compared to standard rehabilitation, with uncertainty about its clinically significant benefits over standard rehabilitation.

Trends and associations between kinesiophobia and knee function from preoperatively to three and six months postoperatively in patients post-ACL reconstruction surgery.

OBJECTIVE: This study aimed to clarify the relationship between the transition of kinesiophobia and knee joint function from the preoperative period to three months postoperative, the time to resume running, six months post-ACLR, and the goal time to resume sports. METHODS: 54 patients who underwent initial ACLR were included in this study. The Tampa Scale for Kinesiophobia-11 (TSK-11) was used to assess kinesiophobia. One-way ANOVA was performed for the preoperative, three-month postoperative, and six-month postoperative endpoints. To examine changes in knee function associated with changes in TSK-11, we calculated correlations between the differences at each time point. RESULTS: TSK-11 decreased significantly at both three and six months postoperatively compared with the preoperative level, but there was no significant change between three months and six months postoperatively. Similar to the decrease in TSK-11 from preoperatively to three and six months postoperatively, there was an improvement in flexion ROM, Pain, Subjective knee function, but none of these changed significantly from three to six months postoperatively. CONCLUSION: There may be significant improvements in knee function associated with TSK-11 reduction up to three months postoperatively.

Association between knee function and kinesiophobia 6 months after anterior cruciate ligament reconstruction.

[Purpose] Kinesiophobia after anterior cruciate ligament reconstruction has been identified as an inhibitor of return to sports. This study aimed to clarify the relationship between kinesiophobia and knee function 6 months after anterior cruciate ligament reconstruction when the patient intends to return to sports. [Participants and Methods] A total of 66 patients who underwent primary anterior cruciate ligament reconstruction (mean age 17.3 ± 2.6 years, 17 males and 49 females, Tegner activity score ≥7) were included in the study. The 11-item version of Tampa scale of kinesiophobia was used to evaluate kinesiophobia 6 months postoperatively. Knee function was evaluated with knee extension muscle strength, tibial anterior displacement, heel buttock distance, heel height difference, anterior knee pain score, and single-leg hop test. The relationship between Tampa scale of kinesiophobia, patient characteristics, and knee function was investigated. [Results] A low Anterior knee pain score and low single-leg hop test, male gender, and age were significant factors associated with kinesiophobia. [Conclusion] Kinesiophobia was associated with a low anterior knee pain score and low single-leg hop test 6 months after anterior cruciate ligament reconstruction. Patients with a low single-leg hop test score or severe pain may need rehabilitation to reduce kinesiophobia.