Department of Orthopaedic Surgery, Wake Forest School of Medicine, Charlotte, NC, USA.
Centre for Sport, Exercise and Osteoarthritis Research-Versus Arthritis, University of Oxford, Oxford, UK.
Sports Med. 2022 Dec;52(12):3001-3019. doi: 10.1007/s40279-022-01739-3. Epub 2022 Aug 13.
To improve the understanding of the psychological impacts of anterior cruciate ligament (ACL) injury, a systematic review synthesizing the evidence on knee self-efficacy, fear avoidance beliefs and kinesiophobia following ACL injury is needed.
The aim of this systematic review was to investigate knee self-efficacy, fear avoidance beliefs and kinesiophobia following ACL injury, and compare these outcomes following management with rehabilitation alone, early and delayed ACL reconstruction (ACLR).
Seven databases were searched from inception to April 14, 2022. Articles were included if they assessed Tampa Scale of Kinesiophobia (TSK), Knee Self-Efficacy Scale (KSES), or Fear Avoidance Beliefs Questionnaire (FABQ). Risk of bias (RoB) was assessed using domain-based RoB tools (ROBINS-1, RoB 2, RoBANS), and GRADE-assessed certainty of evidence. Random-effects meta-analyses pooled outcomes, stratified by time post-injury (pre-operative, 3-6 months, 7-12 months, > 1-2 years, > 2-5 years, > 5 years).
Seventy-three studies (70% high RoB) were included (study outcomes: TSK: 55; KSES: 22; FABQ: 5). Meta-analysis demonstrated worse kinesiophobia and self-efficacy pre-operatively (pooled mean [95% CI], TSK-11: 23.8 [22.2-25.3]; KSES: 5.0 [4.4-5.5]) compared with 3-6 months following ACLR (TSK-11: 19.6 [18.7-20.6]; KSES: 19.6 [18.6-20.6]). Meta-analysis suggests similar kinesiophobia > 3-6 months following early ACLR (19.8 [4.9]) versus delayed ACLR (17.2 [5.0]). Only one study assessed outcomes comparing ACLR with rehabilitation only.
Knee self-efficacy and kinesiophobia improved from pre-ACLR to 3-6 months following ACLR, with similar outcomes after 6 months. Since the overall evidence was weak, there is a need for high-quality observational and intervention studies focusing on psychological outcomes following ACL injury.
为了更好地了解前交叉韧带（ACL）损伤的心理影响，需要对 ACL 损伤后膝关节自我效能、恐惧回避信念和运动恐惧的证据进行系统综述。
本系统综述旨在调查 ACL 损伤后膝关节自我效能、恐惧回避信念和运动恐惧，并比较单独康复管理、早期和延迟 ACL 重建（ACLR）后的这些结果。
从 2022 年 4 月 14 日开始，在 7 个数据库中进行检索。如果文章评估了坦帕运动恐惧量表（TSK）、膝关节自我效能量表（KSES）或恐惧回避信念问卷（FABQ），则将其纳入。使用基于领域的 RoB 工具（ROBINS-1、RoB 2、RoBANS）评估偏倚风险（RoB），并使用 GRADE 评估证据确定性。随机效应荟萃分析汇总了按损伤后时间（术前、3-6 个月、7-12 个月、>1-2 年、>2-5 年、>5 年）分层的结果。
共纳入 73 项研究（70%为高 RoB）（研究结果：TSK：55；KSES：22；FABQ：5）。荟萃分析表明，与 ACLR 后 3-6 个月相比，术前的运动恐惧和自我效能较差（汇总均值[95%CI]，TSK-11：23.8[22.2-25.3]；KSES：5.0[4.4-5.5]）。荟萃分析表明，早期 ACLR 后 3-6 个月的运动恐惧相似（19.8[4.9]）与延迟 ACLR（17.2[5.0]）。只有一项研究评估了 ACLR 与单独康复治疗比较的结果。
ACL 重建前膝关节自我效能和运动恐惧从术前改善到 ACLR 后 3-6 个月，6 个月后结果相似。由于整体证据较弱，因此需要进行高质量的观察性和干预性研究，重点关注 ACL 损伤后的心理结果。
