Kinesiophobia after anterior cruciate ligament rupture and reconstruction: noncopers versus potential copers

J Orthop Sports Phys Ther. 2013 Nov;43(11):821-32. doi: 10.2519/jospt.2013.4514. Epub 2013 Sep 9.


Study design: Secondary-analysis, longitudinal cohort study.

Objectives: To compare kinesiophobia levels in noncopers and potential copers at time points spanning pre- and post-anterior cruciate ligament (ACL) reconstruction and to examine the association between changes in kinesiophobia levels and clinical measures.

Background: After ACL injury, a screening examination may be used to classify patients as potential copers or noncopers based on dynamic knee stability. Quadriceps strength, single-leg hop performance, and self-reported knee function are worse in noncopers. High kinesiophobia levels after ACL reconstruction are associated with poorer self-reported knee function and lower return-to-sport rates. Kinesiophobia levels have not been examined before ACL reconstruction, across the transition from presurgery to postsurgery, or based on potential coper and noncoper classification.

Methods: Quadriceps strength indexes, single-leg hop score indexes, self-reported knee function (Knee Outcome Survey activities of daily living subscale, global rating scale), and kinesiophobia (Tampa Scale of Kinesiophobia [TSK-11]) scores were compiled for potential copers (n = 50) and noncopers (n = 61) from 2 clinical trial databases. A repeated-measures analysis of variance was used to compare TSK-11 scores between groups and across 4 time points (before preoperative treatment, after preoperative treatment, 6 months post-ACL reconstruction, and 12 months post-ACL reconstruction). Correlations determined the association of kinesiophobia levels with other clinical measures.

Results: Presurgery TSK-11 scores were significantly higher in noncopers than in potential copers. Postsurgery, no group differences existed. TSK-11 scores in both groups decreased across all time points; however, TSK-11 scores decreased more in noncopers in the interval between presurgery and postsurgery. In noncopers, the decreases in TSK-11 scores from presurgery to postsurgery and after surgery were related to improvements in the Knee Outcome Survey activities of daily living subscale, whereas the association was only present in potential copers after surgery.

Conclusion: Kinesiophobia levels were high in both noncopers and potential copers preoperatively. Restoration of mechanical knee stability with surgery might have contributed to decreased kinesiophobia levels in noncopers. Kinesiophobia is related to knee function after surgery, regardless of preoperative classification as a potential coper or noncoper.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological*
  • Adolescent
  • Adult
  • Anterior Cruciate Ligament Injuries*
  • Anterior Cruciate Ligament Reconstruction / psychology*
  • Female
  • Humans
  • Knee Injuries / complications
  • Knee Injuries / psychology*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Phobic Disorders / etiology*
  • Young Adult