Kinesiophobia Associates With Physical Performance in Patients With ACL Reconstruction: A Critically Appraised Topic.

Clinical scenario: Anterior cruciate ligament (ACL) injuries remain one of the most common and debilitating injuries that physically active individuals experience. Pain-related fear of movement and/or reinjury, or kinesiophobia, is the most frequently cited reason for not returning to sport after ACL reconstruction. Understanding how kinesiophobia may impact recovery of physical performance is essential to guide targeted rehabilitation.

Clinical question: Does kinesiophobia associate with physical performance in patients with a history of ACL reconstruction?

Summary of key findings: Five cross-sectional studies investigating bivariate relationships between kinesiophobia and metrics of physical performance among individuals with a history of primary, unilateral ACL reconstruction were included. From a strength perspective, greater kinesiophobia associated with lesser isometric knee flexion torque (n = 1, negligible association) but did not associate with isokinetic or isometric knee extension torque (n = 2). In terms of functional movement, greater kinesiophobia associated with asymmetric single-leg step-down performance (n = 1, high association) and shorter single-leg hop distance (n = 1, negligible association). Biomechanically, greater kinesiophobia associated with worse drop jump landing, characterized by greater frontal plane motion and lesser sagittal plane motion at the hip and knee joints (n = 1, low to high association).

Clinical bottom line: Very low-quality evidence suggests a muscle-specific association between kinesiophobia and strength. Low- to moderate-quality evidence suggests that greater kinesiophobia associates with worse functional movement and landing biomechanics.

Strength of recommendation: Considering the consistency and level of evidence among the included studies, we offer the following grades for each construct of physical performance evaluated: strength, D; functional movement, B; and biomechanics, B.