Connecticut Medicine

Mar 2015

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volume 79, no. 3 155 Kinesiophobia and Return to Sports After Anterior Cruciate Ligament Reconstruction Michael J. Medvecky, Md and Stephen nelSon, Md A bStR ACt — Anterior cruciate ligament (ACL) reconstruction is typically recommended for patients who wish to return to aggressive athletic activity. Unfortunately, reconstructive knee surgery is not a guarantee that all patients will return to their preinjury level of function. A recent meta-analysis including 48 studies showed that after a mean follow- up of 41 months, 82% of participants had returned to some kind of athletic activity but only 63% returned to their preinjury level of participation and a disap- pointing 44% returned to competitive sports. 1 e reasons why some athletes have been unsuccessful in returning to previous levels of activity are vast and our understanding of these factors is limited. e importance of psychological factors has recently been emphasized. One such factor, kinesiophobia, or fear of reinjury, may play a significant role in some patients' inability to successfully return to their previous level of sports participation. In the meta- analysis, kinesiophobia was the most common reason cited for postoperative reduction in, or cessation of, sports participation. k nee injuries are one of the most common musculoskeletal complaints among primary care providers with a prevalence of 48 per 1,000 patients per year. 2 in approximately 9% of these com- plaints, there is ligament injury, of which the anterior cruciate ligament (acl) is one of the most commonly injured. 3,4 is common injury results in approximately 100,000 acl reconstructions performed per year in the United States. 3,5,6 an acl injury most commonly occurs via a noncontact injury mechanism as a result of: planting and cutting, landing on an extended knee, one-step stop landing with the knee hyperextended, or pivoting and sudden deceleration. e patient typically reports a "pop" during the event, immediate pain, limited weight-bearing ability, and progressive knee swelling. an acl rupture can be diagnosed through history and physical examination but is confirmed through magnetic resonance imaging (MRi). e treatment for an acl tear is evaluated on an individual patient basis, as surgery is not an obligatory treatment for an acl tear. each individual's activity goals, lifestyle choices, and occupational or educational demands are factors to be taken into consideration when arriving at a treatment plan. e main goal is to reach the optimal function level of the patient without risk- ing further damage. 7 however, for an athlete to return to play and prevent further damage to their knee, acl reconstruction surgery is typically recommended. it is felt that surgical reconstruction lessens the risks of develop- ment of articular cartilage damage, meniscal tears, and osteoarthritis of the knee. 3,8 Surgery is the preferred treat- ment for a complete rupture of the acl in an individual who wishes to return to high-risk activities, defined as: sports, heavy work, and aggressive recreational activity involving pivoting and cutting. acl reconstruction may also be indicated in the nonathletic patient who reports repeated sudden collapse or "giving out" of the knee in spite of adequate rehabilitation. 3,5 Michael J. Medvecky, Md, associate professor, department of orthopaedics & Rehabilitation, yale University School of Medicine; Stephen nelSon, Md, Resident, department of orthopaedics & Rehabilitation, yale University School of Medicine; Corresponding author: Michael J. Med- vecky, Md, michael.medvecky@yale.edu.

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