The goal of this observational study is to evaluate psychological readiness, kinesiophobia, subjective knee function, sport activity level, and return-to-sport status in athletes who have undergone primary anterior cruciate ligament (ACL) reconstruction between 3 and 24 months after surgery. The main questions it aims to answer are: Do these outcomes differ across different postoperative time periods? Are they associated with return-to-sport status? Participants will complete questionnaires assessing psychological readiness (ACL-RSI), kinesiophobia (TSK), subjective knee function (IKDC), and sport activity level (Tegner), and will provide information about their return-to-sport status.
Anterior cruciate ligament (ACL) injury is one of the most common knee injuries in athletes participating in pivoting and cutting sports. Primary ACL reconstruction is widely performed to restore knee stability, improve functional performance, and facilitate return to sport. Despite advances in surgical techniques and rehabilitation protocols, many athletes do not return to their preinjury level of sports participation. Increasing evidence suggests that successful recovery after ACL reconstruction depends not only on physical function but also on psychological factors. Psychological readiness to return to sport has emerged as an important determinant of rehabilitation outcomes following ACL reconstruction. Fear of reinjury, lack of confidence in the reconstructed knee, and reduced self-efficacy may delay or prevent return to sport even in individuals who demonstrate satisfactory physical recovery. Patient-reported outcome measures, including the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale, the Tampa Scale for Kinesiophobia (TSK), the International Knee Documentation Committee (IKDC) Subjective Knee Form, and the Tegner Activity Scale, are commonly used to evaluate these psychological and functional aspects of recovery. Previous studies have reported significant relationships between psychological readiness, kinesiophobia, subjective knee function, and return-to-sport outcomes following ACL reconstruction. However, most investigations have focused on single postoperative time points or relatively homogeneous patient populations. Consequently, limited evidence is available regarding how these outcomes change throughout different stages of postoperative recovery and whether the relationships among these variables differ according to time since surgery. The aim of this observational cross-sectional study is to evaluate psychological readiness, kinesiophobia, subjective knee function, sport activity level, and return-to-sport status in athletes who have undergone primary ACL reconstruction between 3 and 24 months after surgery. Participants will be classified according to postoperative recovery period, allowing comparisons between different stages of rehabilitation. Psychological readiness will be evaluated using the ACL-RSI, kinesiophobia using the TSK, subjective knee function using the IKDC Subjective Knee Form, and sport activity level using the Tegner Activity Scale. Information regarding return-to-sport status and relevant demographic and clinical characteristics will also be collected. The study will investigate differences in these outcomes across postoperative recovery periods and examine the relationships between psychological and functional recovery and return-to-sport status. The findings of this study are expected to improve understanding of the recovery process following ACL reconstruction and provide clinicians with evidence regarding the timing of psychological and functional recovery. The results may contribute to optimizing rehabilitation strategies, identifying athletes who require additional psychological support, and improving clinical decision-making related to return to sport.
Study Type
OBSERVATIONAL
Enrollment
200
Istanbul University
Istanbul, Turkey (Türkiye)
Psychological readiness to return to sport [Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI)]
Psychological readiness to return to sport assessed using the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale. The 12-item scale evaluates psychological readiness to return to sport following ACL injury or reconstruction, including emotional response, confidence in performance, and risk appraisal. The total score ranges from 0 to 100, with higher scores indicating greater psychological readiness to return to sport.
Time frame: At study assessment (single assessment performed between 3 and 24 months after ACL reconstruction)
Kinesiophobia (Tampa Scale for Kinesiophobia [TSK])
Kinesiophobia assessed using the Tampa Scale for Kinesiophobia (TSK). Higher scores indicate greater fear of movement and reinjury. The TSK consists of 17 items, with each item scored on a 4-point response scale. The total score ranges from 17 to 68 points. Higher scores indicate greater levels of kinesiophobia and fear of movement/reinjury, whereas lower scores indicate lower levels of kinesiophobia.
Time frame: At study assessment (single assessment performed between 3 and 24 months after ACL reconstruction)
Subjective knee function (International Knee Documentation Committee [IKDC] Subjective Knee Form)
Subjective knee function assessed using the International Knee Documentation Committee (IKDC) Subjective Knee Form. Scores range from 0 to 100, with higher scores indicating better perceived knee function.
Time frame: At study assessment (single assessment performed between 3 and 24 months after ACL reconstruction)
Sport activity level (Tegner Activity Scale)
Sport activity level assessed using the Tegner Activity Scale. The scale ranges from 0 to 10, with higher scores indicating higher levels of physical activity and sports participation.
Time frame: At study assessment (single assessment performed between 3 and 24 months after ACL reconstruction). Preinjury and current Tegner scores will be recorded to evaluate changes in activity level following primary ACL reconstruction.
Return-to-sport status
Return-to-sport status will be assessed by determining whether participants have returned to their preinjury sport and whether they have returned to their preinjury level of sports participation at the time of assessment. Return-to-sport status will be assessed by classifying participants according to whether they have not returned to sport, have returned at a lower level than before injury, or have returned to their preinjury level of sports participation.
Time frame: At study assessment (single assessment performed between 3 and 24 months after primary ACL reconstruction)
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