Nedder Victoria J, Raju Akash G, Moyal Andrew J, Calcei Jacob G, Voos James E
University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Case Western Reserve University School of Medicine, Cleveland, Ohio.
Sports Health. 2025 Mar;17(2):291-298. doi: 10.1177/19417381241256930. Epub 2024 Jul 23.
Anterior cruciate ligament (ACL) tears are a common orthopaedic injury, and the incidence of ACL reconstruction (ACLR) continues to increase. Current clinical practice guidelines (CPGs) recognize the role of psychological factors in rehabilitation, but patient-reported outcome measures (PROs) and psychological readiness are rarely incorporated into rehabilitation.
The purpose of this review was to highlight the importance of psychological health after ACL injury, understand the current metrics used to monitor psychological recovery, and outline how psychological recovery can be better incorporated in current CPGs.
A systematic review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA); 63 studies were identified with a PubMed search using the term "ACL Injuries/psychology".
Exclusion criteria included lack of consideration of psychological effects or studies validating PROs after ACLR. Studies were reviewed by multiple reviewers, and a total of 38 studies were included after applying exclusion criteria.
Systematic review.
Level 3b.
Two independent reviewers analyzed the included articles to extract sample size, psychological readiness scale or other measures used, and key results.
Psychological outcomes, especially kinesiophobia and fear of reinjury, are seen commonly after ACLR. Psychological factors were shown to impede return to sport (RTS), alter measurable knee biomechanics, and potentially increase the risk for re-rupture. Targeted interventions such as kinesiotaping, knee bracing, and imagery training can help improve psychological and functional testing after ACLR.
ACLR is often complicated by psychological factors. Psychological readiness is a crucial yet often unincorporated part of rehabilitation. Patients with higher levels of kinesiophobia and lower psychological readiness to RTS specifically should be identified to allow for administration of interventions, such as imagery training, knee bracing, or kinesiotaping, that can mitigate the negative effects of psychological outcomes and improve recovery.
前交叉韧带（ACL）撕裂是一种常见的骨科损伤，且ACL重建术（ACLR）的发病率持续上升。当前的临床实践指南（CPG）认可心理因素在康复中的作用，但患者报告的结局指标（PRO）和心理准备情况很少被纳入康复过程。
本综述的目的是强调ACL损伤后心理健康的重要性，了解目前用于监测心理恢复的指标，并概述如何能更好地将心理恢复纳入当前的CPG中。
使用系统评价与Meta分析的首选报告项目（PRISMA）指南进行了一项系统评价；通过在PubMed上搜索“ACL损伤/心理学”一词，确定了63项研究。
排除标准包括未考虑心理影响或验证ACLR后PROs的研究。由多名评审员对研究进行审查，应用排除标准后共纳入38项研究。
系统评价。
3b级。
两名独立评审员分析纳入的文章，以提取样本量、心理准备量表或使用的其他测量方法以及关键结果。
心理结局，尤其是运动恐惧和再次受伤恐惧，在ACLR后很常见。心理因素被证明会阻碍恢复运动（RTS）、改变可测量的膝关节生物力学，并可能增加再次断裂的风险。针对性的干预措施，如肌内效贴布、膝关节支具和意象训练，有助于改善ACLR后的心理和功能测试。
ACLR常因心理因素而复杂化。心理准备是康复过程中一个关键但往往未被纳入的部分。应识别出运动恐惧程度较高且对RTS心理准备较低的患者，以便进行干预，如意象训练、膝关节支具或肌内效贴布，这些干预可以减轻心理结局的负面影响并改善恢复情况。
