Abstract
PURPOSE: The aim of this study was to longitudinally investigate the prevalence and impact of high-level kinesiophobia in adolescents and young adults undergoing anterior cruciate ligament (ACL) reconstruction. METHODS: In this retrospective cohort study conducted January 2018-January 2022, patients aged 16-21 undergoing ACL reconstruction were assessed before, and at 3 and 12 months postoperatively. Baseline characteristics were extracted from medical records. Kinesiophobia (Tampa Scale for Kinesiophobia, TSK-17), subjective knee function (International Knee Documentation Committee, IKDC), readiness to return to sport (RTS) (ACL-return to sport after injury, ACL-RSI), and activity level (Tegner activity scale) were collected via an online questionnaire. Patients were categorized into high or low level kinesiophobia using a 37-point cut-off. Change in prevalence of kinesiophobia was analysed using the χ (2) test. Univariate logistic regression identified predictors of a high level of kinesiophobia at 12 months after ACL reconstruction. To explore the impact of kinesiophobia, between-group differences in patient-reported outcome measures over time were tested using repeated measures analysis of variance. RESULTS: Data of 98 patients were available. Preoperatively, the prevalence of high kinesiophobia was 63.3%, decreasing to 37.8% at 3 months and to 26.7% at 12 months. Preoperative kinesiophobia was the only significant predictor of postoperative kinesiophobia (p = 0.002). The high kinesiophobia group scored significantly lower on IKDC (p < 0.001) and ACL-RSI (p < 0.001). Both groups improved over time on Tegner (p < 0.001), IKDC (p < 0.001) and ACL-RSI (p < 0.001). CONCLUSIONS: High kinesiophobia is common in adolescents and young adults undergoing ACL reconstruction. Kinesiophobia decreased the most in the first three months after reconstruction. In the group with high kinesiophobia, the knee function and readiness to RTS were significantly lower. This significant difference persists over time, despite a significant improvement in both groups. This study emphasizes the need to understand and address psychological characteristics in ACL rehabilitation. LEVEL OF EVIDENCE: Level III.