Fear of reinjury (kinesiophobia) and persistent knee symptoms are common factors for lack of return to sport after anterior cruciate ligament reconstruction

Arthroscopy. 2013 Aug;29(8):1322-9. doi: 10.1016/j.arthro.2013.05.015.


Purpose: Our purpose was to determine patient-cited reasons for lack of return to sport after anterior cruciate ligament reconstruction.

Methods: All patients who underwent primary or revision anterior cruciate ligament reconstruction by 2 surgeons from 2007 to 2008 (N = 171) were contacted for a telephone interview. Patients who did not return to preinjury levels by self-assessment were then asked to cite contributing factors from a predetermined list. These included non-knee-related life events, persistent knee symptoms, fear of reinjury (kinesiophobia), and choice-related options (such as lack of interest or time).

Results: Of the 135 patients who completed the interview, 62 (46%) reported a return to preinjury activity levels (returners) whereas 73 (54%) did not (non-returners). Returners (26.4 ± 10.9 years) were younger than non-returners (30.0 ± 9.8 years) (P = .04). Persistent knee symptoms (68%) and kinesiophobia (52%) were more commonly cited as reasons for not returning to sport than non-knee-related life events (29%), including children, job/education, or health problems (P < .001 for symptoms and P = .004 for kinesiophobia). Among non-returners who cited knee symptoms, 50% concurrently cited kinesiophobia and 24% cited life events.

Conclusions: A lack of return to preinjury activity levels is common after anterior cruciate ligament reconstruction. A majority of patients who do not return to their preinjury activities cite persistent knee symptoms, particularly pain, as a contributing factor, and only a minority of patients cite job and family demands or a lack of interest. Finally, fear of reinjury was cited by half of the patients who did not return to sport.

Level of evidence: Level III, retrospective comparative study.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament / surgery*
  • Anterior Cruciate Ligament Injuries*
  • Anterior Cruciate Ligament Reconstruction / psychology*
  • Attitude to Health*
  • Competitive Behavior
  • Female
  • Humans
  • Knee Injuries / psychology*
  • Knee Injuries / surgery*
  • Knee Joint / surgery
  • Male
  • Middle Aged
  • Population Surveillance
  • Reoperation
  • Retrospective Studies
  • Secondary Prevention
  • Sports / classification
  • Sports / psychology*
  • Young Adult