The Relationship Between Psychological Readiness to Return to Sport and Kinesiophobia in Teens and Young Adults After Anterior Cruciate Ligament Reconstruction

Lauren Butler^1,2*Shelby Baez³Cody Walker⁴Dylan Roman⁵Taylor Douthit^6,7Christopher Kuenze⁸ARROW .⁹Sophia Ulman^10,7

• ¹Department of Physical Therapy, Florida International University, Miami, United States
• ²Department of Rehabilitation, Nicklaus Children’s Hospital, Miami, United States
• ³Department of Exercise and Sport Science, University of North Carolina at Chapel Hil, Chapel Hill, United States
• ⁴Department of orthopedic and Sports Medicine, Arkansas Children’s Hospital, Little Rock, United States
• ⁵Department of Sports Physical Therapy, Connecticut Children’s, Hartford, United States
• ⁶Department of Sports Rehabilitation, Children’s Health Andrews Institute, Plano, United States
• ⁷Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, United States
• ⁸Department of Kinesiology, University of Virginia, Charlottesville, United States
• ⁹University of Viginia, Charlottesville, United States
• ¹⁰Movement Science Lab, Scottish Rite for Children, Dallas, United States

Abstract Introduction: Psychological readiness and kinesiophobia are important variables to consider for return to sport clearance after anterior cruciate ligament (ACL) reconstruction. Both have been associated in adult populations; however, it is unknown if they are associated in teens after ACL reconstruction. Therefore, the purpose of this study was to assess the relationship between psychological readiness and kinesiophobia in teens and young adults after ACL reconstruction. Methods: A retrospective cohort design was used. Participants aged 13-30 years, who were 6-12 months post-ACL reconstruction, who completed the Tampa Scale of Kinesiophobia and the ACL Return-to-Sport after Injury Scale were included from a multi-site registry. Two age groups were established (teen: <19 years, adult: ≥19 years), and psychological readiness was categorized using an ACL Return-to-Sport after Injury Scale cutoff of 77 (<77 = unacceptable). Independent samples t-tests, Pearson correlations, and binary logistic regression were performed to examine associations between kinesiophobia and psychological readiness, and the influences of age, sex, and months since surgery. Results: 315 participants (54.3% female; 18.3±3.3 years; 8.2±1.9 months post-surgery) were analyzed. ACL Return-to-Sport after Injury Scale and Tampa Scale of Kinesiophobia scores were significantly correlated in both groups (teen: r=-0.59, p<0.001; adult: r=-0.45, p<0.001), with no significant difference in the correlation coefficients (z=-1.49). Overall, 47.9% scored below the ACL Return-to-Sport after Injury pass threshold. Each one-point increase in kinesiophobia was associated with a 28% higher likelihood of reporting unacceptable psychological readiness. Adults were twice as likely as teens to report unacceptable psychological readiness. Discussion: Greater psychological readiness was associated with lower kinesiophobia in both teens and young adults. Additionally, nearly half reported poor psychological readiness, highlighting the need for interventions aimed at improving psychological readiness during ACL rehabilitation.