Association of Grit With Postoperative Knee Outcomes and Physical Function After ACL Reconstruction in Adolescent Athletes

Am J Sports Med. 2023 Sep;51(11):2900-2907. doi: 10.1177/03635465231187040. Epub 2023 Jul 31.


Background: Grit is the disposition to strive for long-term goals despite setbacks and challenges. Given the lengthy, arduous process of rehabilitation after anterior cruciate ligament reconstruction (ACLR), an athlete's grit may predict postoperative outcomes across time.

Purpose/hypothesis: The primary aim of the study was to evaluate the relationships between baseline (preoperative) grit and postoperative knee outcomes across the year after ACLR among adolescents. We hypothesized that athletes with more grit would achieve better postoperative outcomes over time than less gritty athletes.

Study design: Cohort study; Level of evidence, 2.

Methods: All participants completed the Short Grit Scale, the Pediatric International Knee Documentation Committee (Pedi-IKDC) Scale, the Lysholm Knee Scoring Scale, the Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric scale for pain interference and mobility, the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS), and the Quality of Life in Neurological Disorders (NeuroQoL) Lower Extremity Function Short Form at a preoperative appointment and then again at approximately 3, 6, and 12 months after ACLR. We constructed linear mixed models to assess the relationships between baseline grit, time, age, sex, and postoperative outcome measures (statistical significance of α = .05).

Results: We included 137 participants (mean age 15.8 ± 2.74 years, 70% female) from a prospective registry of athletes undergoing ACLR by 1 surgeon at a single institution. There were no statistically significant changes in grit over time or differences in grit between age and sex. Higher baseline grit was significantly associated with greater postoperative HSS Pedi-FABS scores (β = 3.72 ± 1.46; P = .01; 95% CI, 0.85-6.59) and NeuroQoL scores across time (β = 3.37 ± 0.93; P < .001; 95% CI, 1.55-5.20). There were no significant associations between baseline grit and Pedi-IKDC, Lysholm, and PROMIS pain interference or mobility scores.

Conclusion: Athletes with higher baseline grit reported superior postoperative physical function and activity level over the course of 1 year after ACLR compared with less gritty athletes. Grit may be a useful measure in predicting success in regaining physical function across time after ACLR in adolescent athletes.

Keywords: ACL; knee; pediatric sports medicine; psychological aspects of sport.

MeSH terms

  • Adolescent
  • Anterior Cruciate Ligament Injuries* / surgery
  • Anterior Cruciate Ligament* / surgery
  • Athletes
  • Child
  • Cohort Studies
  • Female
  • Humans
  • Knee Joint / surgery
  • Lower Extremity
  • Male
  • Pain
  • Quality of Life
  • Return to Sport