OMAR SALEM AHMED ALQASEM, AMRO KHALID SAAD ALTHUWAYQIB, ABDULRAHMAN SAUD ABDULRAHMAN ALASMARI, YASMYEEN OMAR ABDULAZIZ ALAQEEL, ,FAISAL NASSER SHAFEQ KURDI, ABDULAZIZ MUTEB ABTAN ALSHAMMARI, SALEH WALEED SALEH ALOLAYAN, ABDULAZIZ MOHAMMAD SULIMAN ALZUGHAIBI
DOI: https://doi.org/Background: Anterior cruciate ligament reconstruction (ACLR) is a commonly performed surgical procedure aimed at restoring knee stability and facilitating a return to sport (RTS). However, psychological factors, such as fear of re-injury and kinesiophobia, significantly impact functional recovery and RTS outcomes. This systematic review examines the characteristics, psychological outcomes, and functional recovery of athletes post-ACLR, with a focus on fear-avoidance behavior, psychological readiness, and factors influencing RTS confidence.
Methodology: A comprehensive literature search was conducted to identify studies assessing psychological and functional recovery following ACLR. The included studies, primarily cross-sectional in design, were evaluated for population characteristics, assessment tools, and key findings related to fear of re-injury and psychological readiness. Psychological outcomes were measured using validated scales, including the Tampa Scale of Kinesiophobia (TSK), ACL-Return to Sport after Injury (ACL-RSI), and Lower Extremity Functional Scale (LEFS).
Results: The included studies shared common themes related to psychological and functional recovery post-ACLR. Athletes recovering from ACLR demonstrated varying levels of psychological readiness, with fear of re-injury identified as a critical barrier to RTS. Abdelraouf et al. (2025) validated the Arabic version of the Injury-Psychological Readiness to Return to Sport Scale (I-PRRS), which showed strong internal consistency (α = 0.84) and reliability (ICC = 0.88) and correlated moderately with TSK scores (rs = 0.69, p < 0.05). Almansour et al. (2023) and Alswat et al. (2021) reported that higher lower limb functionality and frequent post-surgery sports participation were associated with reduced fear and increased RTS confidence. Conversely, Alsuwayi et al. (2023) highlighted persistent fear in nearly half of the ACLR patients despite overall functional improvement, suggesting psychological barriers may linger even after physical recovery.
Conclusion: This systematic review underscores the critical role of addressing psychological factors, particularly fear of re-injury, in post-ACLR rehabilitation. Interventions aimed at improving psychological readiness, reducing kinesiophobia, and enhancing RTS confidence are essential for optimal recovery.
