The relationships between kinesiophobia and clinical outcomes after ACL reconstruction differ by self-reported physical activity engagement

Abstract

Objectives: To investigate whether relationships between kinesiophobia, lower extremity function, and patient-reported function differ by self-reported physical activity engagement after ACL reconstruction (ACLR).

Design: Cross-sectional.

Setting: Laboratory.

Participants: Seventy-seven patients with a primary, unilateral ACLR.

Main outcome measures: Kinesiophobia (TSK-17) was the primary outcome. Lower extremity function included quadriceps and hamstrings strength, fatigue, and hop performance. Patient-reported function included regional function (IKDC, KOOS subscales) and physical activity engagement (Godin Leisure-Time Exercise). Patients were evaluated together, then stratified by LOW and HIGH physical activity. Correlations and multiple regression analyses identified relationships between kinesiophobia and outcome measures.

Results: Greater kinesiophobia was associated with lesser hamstrings strength, hop performance, and patient-reported function. Greater hamstrings fatigue and lesser KOOS_ADL explained greater kinesiophobia in patients reporting LOW physical activity. Lesser triple hop symmetry, crossover hop distance, and IKDC explained greater kinesiophobia in patients reporting HIGH physical activity.

Conclusions: Greater kinesiophobia associated with worse outcomes after ACLR. Relationships differed by self-reported physical activity engagement. Interventions that improve the ability to perform knee-related activities of daily living may be appropriate to minimize the impact of fear in less active patients, while those targeting hop performance and knee-related sport activities may be better suited for more active patients.

Keywords: Fear; Hamstrings; Hop performance; Patient-reported outcomes.