Psychosocial Factors on Athlete Return to Sport Readiness After Anterior Cruciate Ligament Reconstruction: A Critically Appraised Topic.

Clinical scenario: Anterior cruciate ligament (ACL) injuries are a common injury experienced by athletes and often involve lengthy and invasive treatments. Given the literature that exists supporting psychosocial response to injury, it is important to understand how these factors influence the recovery process ultimately influencing readiness to return to play.

Clinical question: What is the impact of psychosocial factors on athlete readiness to return to sport participation post-ACL reconstruction (ACLR)?

Summary of key findings: All studies found that psychosocial factors, including athletic identity, motivation, anxiety, control, and fear, impacted perceived readiness to return to play. Several studies found various levels of influence in both a positive (eg, motivation and resilience) and negative (eg, fear and anxiety) direction. Furthermore, despite presenting more psychosocial barriers than physical, these factors do not appear to influence actual physical recovery.

Clinical bottom line: Psychosocial factors have both direct and indirect effects, positive and negative, on an athlete's perceived readiness to return to the play. ACLR rehabilitation protocols are well developed, well established, and known to be effective; however, athletes still do not feel ready to return, and there are physical and mental risks associated with that uncertainty. Therefore, psychosocial factors are important to include and prioritize as part of the ACLR recovery process to ensure athletes are physically and psychosocially ready to return to play.

Strength of recommendation: Grade B evidence exists that psychosocial factors positively and negatively impact physical recovery and perceptions of recovery on return-to-play post-ACLR.