The roles of acceptance and catastrophizing in rehabilitation following anterior cruciate ligament reconstruction

J Sci Med Sport. 2015 May;18(3):250-4. doi: 10.1016/j.jsams.2014.04.002. Epub 2014 Apr 13.


Objectives: The purpose of this study was to determine if pain catastrophizing and experiential acceptance predicted depression, pain intensity, and maladaptive behaviour following anterior cruciate ligament reconstruction.

Design: Patients who had undergone anterior cruciate ligament surgery completed assessment within 2 weeks of surgery (N=44) and again 6 months post-surgery (N=26).

Methods: Predictor measures were the Pain Catastrophizing Scale and the Acceptance and Action Questionnaire. Outcome measures included the depression scale of the Depression Anxiety and Stress Scale, numerical rating scale of pain intensity, and the alcohol and substance misuse subscale of the Brief Coping Orientations to the Problem Experience inventory. Demographic variables and athletic identity were also measured.

Results: Higher pain catastrophizing scores were associated with greater pain intensity and depressive symptoms in the 2-week post-operative period. Lower acceptance scores in the 2-week post-operative period were predictive of more severe depression scores at 6 months, even after controlling for early post-operative depression and athletic identity. Lower acceptance was also associated with greater use of alcohol and other substances, reportedly to cope with the stress of being injured.

Conclusions: This study highlights the importance of acceptance in an athletic population undergoing rehabilitation after ACL reconstruction.

Keywords: Athletic injuries; Knee injuries; Psychology; Psychometrics.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Alcohol-Related Disorders / etiology*
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries
  • Anterior Cruciate Ligament Reconstruction / psychology*
  • Anterior Cruciate Ligament Reconstruction / rehabilitation
  • Athletic Injuries / psychology*
  • Athletic Injuries / rehabilitation
  • Athletic Injuries / surgery
  • Behavior*
  • Catastrophization / psychology*
  • Depression / etiology*
  • Female
  • Humans
  • Male
  • Pain Measurement
  • Psychiatric Status Rating Scales
  • Social Identification
  • Surveys and Questionnaires
  • Time Factors
  • Young Adult