Subscribe to RSS
DOI: 10.1055/a-2315-8034
Relationship between Kinesiophobia and Dynamic Postural Stability after Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Study
![](https://www.thieme-connect.de/media/jks/EFirst/lookinside/thumbnails/10-1055-a-2315-8034_23sep0106oa-1.jpg)
Abstract
Introduction Anterior cruciate ligament (ACL) injuries in young, active patients generally require ACL reconstruction (ACLR) to restore mechanical and postural stability. The fear of movement or reinjury (kinesiophobia) has become increasingly recognized in the post-ACLR population; however, the association between restoration of postural stability and kinesiophobia remains largely unknown. The purpose of this study was to investigate changes in mean Tampa Scale of Kinesiophobia-11 (TSK-11), dynamic motion analysis (DMA) scores, and time on the testing platform, as well as any correlation between TSK-11 and mean overall and individual translational and rotational DMA scores during the first 12 months following ACLR.
Design Cohort study.
Methods Patients undergoing ACLR were prospectively enrolled and dynamic postural stability and kinesiophobia based on the TSK-11 were collected within 2 days prior to surgery and at 6 and 12 months following ACLR. Dynamic postural stability was quantified by calculating a DMA score, with score calculated in three translational (anterior/posterior [AP], up/down [UD], medial/lateral [ML]) and three rotational (left/right [LR], flexion/extension, and internal/external rotation) independent planes of motions. Correlations between DMA and TSK-11 scores at each time point were analyzed.
Results A total of 25 patients meeting inclusion criteria were analyzed. Mean overall DMA and TSK-11 scores increased with each successive testing interval. At 6-month follow-up, a weakly positive association between TSK-11 and DMA scores was appreciated based on overall DMA, AP, UD, ML, and LR. At 12 months, a moderately positive correlation was appreciated between TSK-11 and the translational, but not rotational, planes of motion.
Conclusions Following ACLR, lower level of kinesiophobia were found to be moderately associated with improved dynamic stability, especially in the translation planes of motion.
Publication History
Received: 27 September 2023
Accepted: 23 April 2024
Accepted Manuscript online:
27 April 2024
Article published online:
30 May 2024
© 2024. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Montalvo AM, Schneider DK, Webster KE. et al. Anterior cruciate ligament injury risk in sport: a systematic review and meta-analysis of injury incidence by sex and sport classification. J Athl Train 2019; 54 (05) 472-482
- 2 Kaeding CC, Léger-St-Jean B, Magnussen RA. Epidemiology and diagnosis of anterior cruciate ligament injuries. Clin Sports Med 2017; 36 (01) 1-8
- 3 Musahl V, Karlsson J. Anterior cruciate ligament tear. N Engl J Med 2019; 380 (24) 2341-2348
- 4 Baer GS, Harner CD. Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction. Clin Sports Med 2007; 26 (04) 661-681
- 5 Wilk KE, Macrina LC, Cain EL, Dugas JR, Andrews JR. Recent advances in the rehabilitation of anterior cruciate ligament injuries. J Orthop Sports Phys Ther 2012; 42 (03) 153-171
- 6 Hartigan EH, Lynch AD, Logerstedt DS, Chmielewski TL, Snyder-Mackler L. Kinesiophobia after anterior cruciate ligament rupture and reconstruction: noncopers versus potential copers. J Orthop Sports Phys Ther 2013; 43 (11) 821-832
- 7 Adams D, Logerstedt DS, Hunter-Giordano A, Axe MJ, Snyder-Mackler L. Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression. J Orthop Sports Phys Ther 2012; 42 (07) 601-614
- 8 Myer GD, Paterno MV, Ford KR, Quatman CE, Hewett TE. Rehabilitation after anterior cruciate ligament reconstruction: criteria-based progression through the return-to-sport phase. J Orthop Sports Phys Ther 2006; 36 (06) 385-402
- 9 Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 2014; 48 (21) 1543-1552
- 10 Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med 2013; 41 (07) 1549-1558
- 11 Brophy RH, Schmitz L, Wright RW. et al. Return to play and future ACL injury risk after ACL reconstruction in soccer athletes from the Multicenter Orthopaedic Outcomes Network (MOON) group. Am J Sports Med 2012; 40 (11) 2517-2522
- 12 Ithurburn MP, Longfellow MA, Thomas S, Paterno MV, Schmitt LC. Knee function, strength, and resumption of preinjury sports participation in young athletes following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2019; 49 (03) 145-153
- 13 Lai CCH, Ardern CL, Feller JA, Webster KE. Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes. Br J Sports Med 2018; 52 (02) 128-138
- 14 Webster KE, McPherson AL, Hewett TE, Feller JA. Factors associated with a return to preinjury level of sport performance after anterior cruciate ligament reconstruction surgery. Am J Sports Med 2019; 47 (11) 2557-2562
- 15 Lentz TA, Zeppieri Jr G, George SZ. et al. Comparison of physical impairment, functional, and psychosocial measures based on fear of reinjury/lack of confidence and return-to-sport status after ACL reconstruction. Am J Sports Med 2015; 43 (02) 345-353
- 16 Xiao M, van Niekerk M, Trivedi NN. et al. Patients who return to sport after primary anterior cruciate ligament reconstruction have significantly higher psychological readiness: a systematic review and meta-analysis of 3744 patients. Am J Sports Med 2023; 51 (10) 2774-2783
- 17 Ardern CL, Taylor NF, Feller JA, Webster KE. Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery. Am J Sports Med 2012; 40 (01) 41-48
- 18 Flanigan DC, Everhart JS, Pedroza A, Smith T, Kaeding CC. Fear of reinjury (kinesiophobia) and persistent knee symptoms are common factors for lack of return to sport after anterior cruciate ligament reconstruction. Arthroscopy 2013; 29 (08) 1322-1329
- 19 Kvist J, Ek A, Sporrstedt K, Good L. Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2005; 13 (05) 393-397
- 20 Marok E, Soundy A. The effect of kinesiophobia on functional outcomes following anterior cruciate ligament reconstruction surgery: an integrated literature review. Disabil Rehabil 2022; 44 (24) 7378-7389
- 21 Shah R, Ghagare J, Shyam A. et al. Prevalence of kinesiophobia in young adults post ACL reconstruction. IJPR 2017; 5 (01) 1798-1801
- 22 Woby SR, Roach NK, Urmston M, Watson PJ. Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia. Pain 2005; 117 (1-2): 137-144
- 23 George SZ, Lentz TA, Zeppieri G, Lee D, Chmielewski TL. Analysis of shortened versions of the Tampa scale for kinesiophobia and pain catastrophizing scale for patients after anterior cruciate ligament reconstruction. Clin J Pain 2012; 28 (01) 73-80
- 24 Bakhsh HR, Metikala S, Billy GG, Vairo GL. Association between self-reported kinesiophobia and single-leg hop for distance in patients with ACL reconstruction: a systematic review. Sports Health 2022; 14 (05) 674-680
- 25 Goldie PA, Bach TM, Evans OM. Force platform measures for evaluating postural control: reliability and validity. Arch Phys Med Rehabil 1989; 70 (07) 510-517
- 26 Nagelli CV, Hewett TE. Should return to sport be delayed until 2 years after anterior cruciate ligament reconstruction? Biological and functional considerations. Sports Med 2017; 47 (02) 221-232
- 27 Paterno MV, Schmitt LC, Ford KR. et al. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med 2010; 38 (10) 1968-1978
- 28 Howells BE, Ardern CL, Webster KE. Is postural control restored following anterior cruciate ligament reconstruction? A systematic review. Knee Surg Sports Traumatol Arthrosc 2011; 19 (07) 1168-1177
- 29 Labanca L, Laudani L, Mariani PP, Macaluso A. Postural adjustments following ACL rupture and reconstruction: a longitudinal study. Int J Sports Med 2018; 39 (07) 549-554
- 30 Meierbachtol A, Obermeier M, Yungtum W. et al. Injury-related fears during the return-to-sport phase of ACL reconstruction rehabilitation. Orthop J Sports Med 2020; 8 (03) 23 25967120909385
- 31 Miko SC, Simon JE, Monfort SM, Yom JP, Ulloa S, Grooms DR. Postural stability during visual-based cognitive and motor dual-tasks after ACLR. J Sci Med Sport 2021; 24 (02) 146-151
- 32 Tavares MLA, Lima POP, Albano TR. et al. The relationship of knee-related quality of life with function, psychological factors, strength, performance, and postural stability after ACL reconstruction: a cross-sectional study. Sports Health 2023; 15 (02) 192-198
- 33 Brophy RH, Schafer KA, Knapik DM. et al. Changes in dynamic postural stability after ACL reconstruction: results over 2 years of follow-up. Orthop J Sports Med 2022; 10 (06) 23 259671221098989
- 34 Brophy RH, Staples JR, Motley J, Blalock R, Steger-May K, Halstead M. Young females exhibit decreased coronal plane postural stability compared to young males. HSS J 2016; 12 (01) 26-31
- 35 Staples JR, Schafer KA, Smith MV. et al. Decreased postural control in patients undergoing anterior cruciate ligament reconstruction compared to healthy controls. J Sport Rehabil 2019; 29 (07) 920-925
- 36 Broglio SP, Sosnoff JJ, Rosengren KS, McShane K. A comparison of balance performance: computerized dynamic posturography and a random motion platform. Arch Phys Med Rehabil 2009; 90 (01) 145-150
- 37 Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Hewett TE. Altered postural sway persists after anterior cruciate ligament reconstruction and return to sport. Gait Posture 2013; 38 (01) 136-140
- 38 Logitech Inc. 3D Mouse & Head Tracker: Technical Reference Manual. Fakespace Inc, Mountain View. 1992
- 39 Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48 (03) 452-458
- 40 Bullock GS, Sell TC, Zarega R. et al. Kinesiophobia, knee self-efficacy, and fear avoidance beliefs in people with ACL injury: a systematic review and meta-analysis. Sports Med 2022; 52 (12) 3001-3019
- 41 Adachi N, Ochi M, Uchio Y, Iwasa J, Ryoke K, Kuriwaka M. Mechanoreceptors in the anterior cruciate ligament contribute to the joint position sense. Acta Orthop Scand 2002; 73 (03) 330-334
- 42 Schultz RA, Miller DC, Kerr CS, Micheli L. Mechanoreceptors in human cruciate ligaments. A histological study. J Bone Joint Surg Am 1984; 66 (07) 1072-1076
- 43 Kapreli E, Athanasopoulos S. The anterior cruciate ligament deficiency as a model of brain plasticity. Med Hypotheses 2006; 67 (03) 645-650
- 44 Konishi YU. ACL repair might induce further abnormality of gamma loop in the intact side of the quadriceps femoris. Int J Sports Med 2011; 32 (04) 292-296
- 45 Lehmann T, Paschen L, Baumeister J. Single-leg assessment of postural stability after anterior cruciate ligament injury: a systematic review and meta-analysis. Sports Med Open 2017; 3 (01) 32
- 46 Chmielewski TL, Jones D, Day T, Tillman SM, Lentz TA, George SZ. The association of pain and fear of movement/reinjury with function during anterior cruciate ligament reconstruction rehabilitation. J Orthop Sports Phys Ther 2008; 38 (12) 746-753
- 47 Lentz TA, Zeppieri Jr G, Tillman SM. et al. Return to preinjury sports participation following anterior cruciate ligament reconstruction: contributions of demographic, knee impairment, and self-report measures. J Orthop Sports Phys Ther 2012; 42 (11) 893-901
- 48 Norte GE, Solaas H, Saliba SA, Goetschius J, Slater LV, Hart JM. The relationships between kinesiophobia and clinical outcomes after ACL reconstruction differ by self-reported physical activity engagement. Phys Ther Sport 2019; 40: 1-9
- 49 Paterno MV, Flynn K, Thomas S, Schmitt LC. Self-reported fear predicts functional performance and second ACL injury after ACL reconstruction and return to sport: a pilot study. Sports Health 2018; 10 (03) 228-233
- 50 Dudley RI, Lohman EB, Patterson CS, Knox KG, Gharibvand L. The relationship between kinesiophobia and biomechanics in anterior cruciate ligament reconstructed females. Phys Ther Sport 2022; 56: 32-37
- 51 Shimokochi Y, Shultz SJ. Mechanisms of noncontact anterior cruciate ligament injury. J Athl Train 2008; 43 (04) 396-408
- 52 Tsai LC, Ko YA, Hammond KE, Xerogeanes JW, Warren GL, Powers CM. Increasing hip and knee flexion during a drop-jump task reduces tibiofemoral shear and compressive forces: implications for ACL injury prevention training. J Sports Sci 2017; 35 (24) 2405-2411
- 53 Padua DA, DiStefano LJ, Hewett TE. et al. National Athletic Trainers' Association Position Statement: prevention of anterior cruciate ligament injury. J Athl Train 2018; 53 (01) 5-19
- 54 van Melick N, van Cingel RE, Brooijmans F. et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med 2016; 50 (24) 1506-1515
- 55 Crombez G, Eccleston C, Van Damme S, Vlaeyen JW, Karoly P. Fear-avoidance model of chronic pain: the next generation. Clin J Pain 2012; 28 (06) 475-483
- 56 Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med 2007; 30 (01) 77-94
- 57 Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000; 85 (03) 317-332
- 58 Bjordal JM, Arnły F, Hannestad B, Strand T. Epidemiology of anterior cruciate ligament injuries in soccer. Am J Sports Med 1997; 25 (03) 341-345
- 59 Lee DY, Karim SA, Chang HC. Return to sports after anterior cruciate ligament reconstruction - a review of patients with minimum 5-year follow-up. Ann Acad Med Singap 2008; 37 (04) 273-278
- 60 Faleide AGH, Magnussen LH, Strand T. et al. The role of psychological readiness in return to sport assessment after anterior cruciate ligament reconstruction. Am J Sports Med 2021; 49 (05) 1236-1243
- 61 Langford JL, Webster KE, Feller JA. A prospective longitudinal study to assess psychological changes following anterior cruciate ligament reconstruction surgery. Br J Sports Med 2009; 43 (05) 377-381
- 62 Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport 2008; 9 (01) 9-15