The association of pain and fear of movement/reinjury with function during anterior cruciate ligament reconstruction rehabilitation

J Orthop Sports Phys Ther. 2008 Dec;38(12):746-53. doi: 10.2519/jospt.2008.2887.


Study design: Cross-sectional.

Objectives: To measure fear of movement/reinjury levels and determine the association with function at different timeframes during anterior cruciate ligament (ACL) reconstruction rehabilitation. We hypothesized that fear of movement/reinjury would decrease during rehabilitation and be inversely related with function.

Background: Fear of movement/reinjury can prevent return to sports after ACL reconstruction, but it has not been studied during rehabilitation.

Methods and measures: Demographic data and responses on the shortened version of Tampa Scale for Kinesiophobia (TSK-11), 8-Item Short-Form Health Survey (SF-8), and International Knee Documentation Committee (IKDC) subjective form were extracted from a clinical database for 97 patients in the first year after ACL reconstruction. Three groups were formed: group 1, less than or equal to 90 days; group 2, 91 to 180 days; group 3: 181 to 372 days post-ACL reconstruction. Group differences in TSK-11 score, SF-8 bodily pain rating, and IKDC scores were determined. Hierarchical linear regression models were created for each group, with IKDC score as the dependent variable and demographic factors, SF-8 bodily pain rating, and TSK-11 score as independent variables.

Results: TSK-11 score was higher in group 1 than in group 3 (P < .05). Across the groups, SF-8 bodily pain rating decreased (P < .001) and IKDC score increased (P < .001). SF-8 bodily pain rating was a significant factor in the regression model for all groups, whereas TSK-11 score only contributed to the regression model in group 3 (partial correlation, -0.529).

Conclusions: Pain was consistently associated with function across the timeframes studied. Fear of movement/reinjury levels appear to decrease during ACL reconstruction rehabilitation and are associated with function in the timeframe when patients return to sports.

Level of evidence: Prognosis, level 4.

MeSH terms

  • Activities of Daily Living
  • Adaptation, Psychological*
  • Adult
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries*
  • Cross-Sectional Studies
  • Fear*
  • Female
  • Health Surveys
  • Humans
  • Knee Injuries / rehabilitation*
  • Knee Joint*
  • Linear Models
  • Male
  • Movement
  • Plastic Surgery Procedures*
  • Prognosis
  • Rehabilitation Centers
  • Surveys and Questionnaires
  • Treatment Outcome