Determinants of Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction

Document Type

Article

Publication Date

10-1-2026

Abstract

Background: Psychological and physical factors influence recovery after anterior cruciate ligament (ACL) reconstruction (ACLR). However, the relative contributions of psychological, subjective, and objective recovery measures to psychological readiness for return to sport remain unclear. Objective: To identify psychological, subjective, and objective recovery factors associated with psychological readiness to return to sport approximately 6 months after ACLR. Design: Cross-sectional study. Setting: University laboratory. Patients or Other Participants: A total of 58 participants (31 [53%] females; age = 18.95 ± 5.20 years), who completed standardized postoperative rehabilitation and follow-up testing at approximately 6 months after primary unilateral ACLR, were included. Main Outcome Measure(s): We measured psychological readiness using the ACL-Return to Sport after Injury (ACL-RSI) scale and conducted hierarchical regression analyses to examine predictors of psychological readiness across 4 conceptually ordered domains: (1) demographics (age, sex, and time since surgery), (2) generalized anxiety (Patient-Reported Outcomes Measurement Information System Anxiety Scale) and kinesiophobia (Tampa Scale for Kinesiophobia 11), (3) knee-specific patient-reported outcomes (Knee Injury and Osteoarthritis Outcomes Scale [KOOS] subscales of Pain, Symptoms, Quality of Life [QoL], and Sport), and (4) objective functional measures (quadriceps strength and single-legged hop symmetry). We conducted hierarchical linear regression in conceptually ordered blocks. Results: Demographic factors explained minimal variance in psychological readiness (1%–4%). Generalized anxiety contributed an additional 18.1%, and kinesiophobia (Tampa Scale for Kinesiophobia 11, 22.3%), QoL (KOOS-QoL, 9.8%), and subjective sport function (KOOS-Sport, 5.3%) emerged as the strongest incremental predictors. Pain, symptoms, and objective function contributed little additional variance. The full model explained 70.5% of the variance in ACL-RSI scores (adjusted R^2 = 0.64, P < .001), and cross-validation produced a comparable R^2 (0.61), indicating good model generalizability and minimal overfitting. Conclusions: Fear-related beliefs and perceived function exerted stronger influences on psychological readiness after ACLR than objective functional symmetry. These findings highlight the importance of biopsychosocial assessment models and sport-specific psychological measures to enhance return-to-sport decision-making and long-term recovery outcomes.

Publication Title

Journal of Athletic Training

Link to Full Text

Share

COinS