Physical Therapy Program, Arcadia University, Glenside, Pennsylvania, USA.
Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA.
Am J Sports Med. 2021 Nov;49(13):3495-3501. doi: 10.1177/03635465211045388. Epub 2021 Oct 8.
Psychological readiness to return to sport has emerged as an important factor associated with outcomes after anterior cruciate ligament reconstruction (ACLR). Psychological factors are potentially modifiable during the course of rehabilitation, and improving them may lead to better outcomes.
To determine whether athletes with a positive psychological response after participation in a neuromuscular training and second injury prevention program had better self-reported function and activity outcomes compared with athletes who did not have a meaningful change.
Cohort study; Level of evidence, 3.
After ACLR and the completion of formal rehabilitation, 66 level I/II athletes completed the following self-reported measures at enrollment (pretraining): the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale, the International Knee Documentation Committee (IKDC) subjective knee form, and the 5 subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS). Participants completed these measures after 10 sessions of agility, plyometric, and progressive strength training and at 1 and 2 years after ACLR. Participants who displayed an increase in the ACL-RSI score from pretraining to posttraining that exceeded the minimal clinically important difference (≥10 points) were defined as having a positive psychological response (responders) to training, and those who did not were defined as nonresponders. A mixed-model analysis of variance was used to determine if group differences in IKDC and KOOS scores existed over the 4 time points (pretraining, posttraining, and the 1- and 2-year follow-ups).
The responders reported better self-reported function compared with the nonresponders, regardless of time, on the IKDC form ( = .001), KOOS-Sport and Recreation ( = .014), KOOS-Pain ( = .007), and KOOS-Symptoms ( = .002) but not on the KOOS-Quality of Life ( = .078). Overall, 77% of responders and 67% of nonresponders returned to their previous level of sport by 1 year after ACLR ( = .358), and 82% of responders and 78% of nonresponders returned to their previous level of sport by 2 years after ACLR ( = .668).
Ultimately, 59% of the athletes in this study displayed a meaningful improvement in their psychological outlook over the course of the training program. Responders demonstrated persistently better self-reported function at posttraining and at 1 and 2 years after ACLR, but there were no between-group differences in return-to-sport rates.
心理准备重返运动已成为与前交叉韧带重建（ACLR）后结果相关的重要因素。心理因素在康复过程中具有潜在的可调节性，改善这些因素可能会带来更好的结果。
确定参加神经肌肉训练和二次损伤预防计划后表现出积极心理反应的运动员与没有明显变化的运动员相比，自我报告的功能和活动结果是否更好。
队列研究；证据水平，3 级。
在 ACLR 后和正式康复完成后，66 名 I/II 级运动员在入组时（训练前）完成了以下自我报告的测量：前交叉韧带损伤后重返运动（ACL-RSI）量表、国际膝关节文献委员会（IKDC）主观膝关节表和膝关节损伤和骨关节炎结果评分（KOOS）的 5 个亚量表。参与者在完成 10 次敏捷性、弹性能量和渐进式力量训练后以及 ACLR 后 1 年和 2 年时完成这些测量。从训练前到训练后 ACL-RSI 评分增加超过最小临床重要差异（≥10 分）的参与者被定义为对训练有积极的心理反应（有反应者），而没有增加的参与者被定义为无反应者。混合模型方差分析用于确定在 4 个时间点（训练前、训练后以及 1 年和 2 年随访）是否存在 IKDC 和 KOOS 评分的组间差异。
无论时间如何，有反应者在 IKDC 表（ =.001）、KOOS-运动和娱乐（ =.014）、KOOS-疼痛（ =.007）和 KOOS-症状（ =.002）上的自我报告功能均优于无反应者，但 KOOS-生活质量（ =.078）则不然。总体而言，77%的有反应者和 67%的无反应者在 ACLR 后 1 年恢复到以前的运动水平（ =.358），82%的有反应者和 78%的无反应者在 ACLR 后 2 年恢复到以前的运动水平（ =.668）。
最终，本研究中有 59%的运动员在训练计划过程中表现出心理状态的显著改善。有反应者在训练后和 ACLR 后 1 年和 2 年的自我报告功能始终更好，但在重返运动率方面没有组间差异。
