Cognitive-behavioral-based physical therapy to enhance return to sport after anterior cruciate ligament reconstruction: An open pilot study

Phys Ther Sport. 2020 Mar;42:82-90. doi: 10.1016/j.ptsp.2020.01.004. Epub 2020 Jan 9.


Objectives: To describe feasibility, adherence, acceptability, and outcomes of a cognitive-behavioral-based physical therapy (CBPT-ACLR) intervention for improving postoperative recovery after anterior cruciate ligament reconstruction (ACLR).

Design: Pilot study.

Setting: Academic medical center.

Participants: Eight patients (mean age [SD] = 20.1 [2.6] years, 6 females) participated in a 7-session telephone-based CBPT-ACLR intervention beginning preoperatively and lasting 8 weeks after surgery.

Main outcome measures: At 6 months, patients completed Knee Injury and Osteoarthritis Outcome Score (KOOS) sports/recreation and quality of life (QOL) subscales, International Knee Documentation Committee (IKDC), Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), and Knee Self-Efficacy Scale (K-SES), return to sport (Subjective Patient Outcome for Return to Sports), and satisfaction. Minimal clinically important difference (MCID) was used for meaningful change.

Results: Seven (88%) patients completed all sessions. Seven (88%) patients exceeded MCID on the TSK, 6 (75%) on the PCS, 5 (63%) on the KOOS sports/recreation subscale, 4 (50%) on the IKDC, and 3 (38%) on the KOOS QOL subscale. Three (38%) patients returned to their same sport at the same level of effort and performance. All patients were satisfied with their recovery.

Conclusions: A CBPT-ACLR program is feasible and acceptable for addressing psychological risk factors after ACLR.

Keywords: Anterior cruciate ligament; Cognitive behavioral therapy; Psychological adaptation; Rehabilitation; Return to sport; Telemedicine.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament Injuries / physiopathology
  • Anterior Cruciate Ligament Injuries / rehabilitation*
  • Anterior Cruciate Ligament Injuries / surgery
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Female
  • Humans
  • Knee Joint / physiopathology*
  • Male
  • Physical Therapy Modalities*
  • Pilot Projects
  • Postoperative Period
  • Quality of Life*
  • Range of Motion, Articular / physiology*
  • Return to Sport / physiology*
  • Young Adult