Nwachukwu Benedict U, Adjei Joshua, Rauck Ryan C, Chahla Jorge, Okoroha Kelechi R, Verma Nikhil N, Allen Answorth A, Williams Riley J
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Orthop J Sports Med. 2019 May 22;7(5):2325967119845313. doi: 10.1177/2325967119845313. eCollection 2019 May.
Variables affecting return to sport after anterior cruciate ligament reconstruction (ACLR) are multifactorial. The nonphysical factors germane to successful return to play (RTP) are being increasingly recognized.
To (1) evaluate the available evidence base for psychological factors relating to RTP after ACLR, (2) identify psychological factors affecting RTP after ACLR, and (3) understand currently available metrics used to assess psychological RTP readiness.
Systematic review; Level of evidence, 4.
A review of the MEDLINE database was performed for studies reporting RTP after ACLR. Studies reporting on the psychological determinants of RTP were included. Demographic, methodological, and psychometric properties of the included studies were extracted. Weighted analysis was performed after patients were pooled across included studies.
Of 999 studies identified in the initial search, 28 (2.8%) studies, comprising 2918 patients, were included; 19 studies (n = 2175 patients) reported RTP rates. The mean time for RTP was 17.2 months. There was a 63.4% rate of RTP, and 36.6% of patients returning to sport were not able to perform at their prior level of play. Of the 795 patients who did not achieve RTP, 514 (64.7%) cited a psychological reason for not returning. Fear of reinjury was the most common reason (n = 394; 76.7%); other psychological factors included lack of confidence in the treated knee (n = 76; 14.8%), depression (n = 29; 5.6%), and lack of interest/motivation (n = 13; 2.5%). The Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, the ACL-Return to Sport after Injury scale, and the Knee Self-Efficacy Scale were reported measures for assessing the influence of psychology on RTP.
Psychological factors play an important role in RTP after ACLR. Among studies evaluating the impact of psychology on RTP, there was a delay in returning as well as lower RTP rates compared with the previously reported normative literature. Fear of reinjury was the most commonly reported impediment to RTP. The psychosocial measures identified in this review may have a role in RTP protocols for assessing mental resiliency; however, their roles need to be further investigated and validated in patients who have undergone ACLR.
影响前交叉韧带重建（ACLR）后恢复运动的因素是多方面的。与成功恢复运动（RTP）相关的非身体因素正日益受到认可。
（1）评估有关ACLR后与RTP相关的心理因素的现有证据基础；（2）确定影响ACLR后RTP的心理因素；（3）了解目前用于评估心理上RTP准备情况的指标。
系统评价；证据等级，4级。
对MEDLINE数据库进行检索，查找报告ACLR后RTP的研究。纳入报告RTP心理决定因素的研究。提取纳入研究的人口统计学、方法学和心理测量学特征。在将纳入研究中的患者合并后进行加权分析。
在初步检索中确定的999项研究中，纳入了28项研究（2.8%），共2918例患者；19项研究（n = 2175例患者）报告了RTP率。RTP的平均时间为17.2个月。RTP率为63.4%，36.6%恢复运动的患者无法达到之前的运动水平。在795例未实现RTP的患者中，514例（64.7%）指出未恢复运动有心理原因。害怕再次受伤是最常见的原因（n = 394；76.7%）；其他心理因素包括对患膝缺乏信心（n = 76；14.8%）、抑郁（n = 29；5.6%）以及缺乏兴趣/动力（n = 13；2.5%）。坦帕运动恐惧量表、医院焦虑抑郁量表、损伤后ACL-恢复运动量表和膝关节自我效能量表是报告的用于评估心理对RTP影响的测量工具。
心理因素在ACLR后的RTP中起重要作用。在评估心理对RTP影响的研究中，与之前报告的规范性文献相比，恢复运动存在延迟且RTP率较低。害怕再次受伤是报告的RTP最常见障碍。本综述中确定的社会心理测量工具可能在评估心理适应能力的RTP方案中发挥作用；然而，它们在接受ACLR的患者中的作用需要进一步研究和验证。
