Fear of Reinjury Following Surgical and Nonsurgical Management of Anterior Cruciate Ligament Injury: An Exploratory Analysis of the NACOX Multicenter Longitudinal Cohort Study.
Stephanie Filbay, Joanna Kvist
PMID 34939109WHAT IT FOUND
Fear of reinjury remained high at 12 months after ACL injury, regardless of whether patients chose surgery or rehabilitation alone.
Patients who later opted for surgery reported worse fear than those who did not. Prognostic factors differed by treatment group, with self-efficacy predicting lower fear only in the rehabilitation group.
Key findings
01Fear of reinjury scores were similar on average between people treated with rehabilitation alone and those treated with ACLR, though patients who initially chose rehabilitation but later underwent surgery reported higher fear.
02Greater baseline general self-efficacy was associated with reduced fear of reinjury at 12 months in patients managed with rehabilitation alone, but this association was not found in patients who underwent ACLR.
03Female sex was associated with greater fear of reinjury at 3 months following ACLR, while better baseline knee function was associated with reduced fear at 12 months following ACLR.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
There is no established, valid outcome measure specifically for fear of reinjury in ACL-injured individuals; the study used single items from broader questionnaires. Rehabilitation strategies were not standardized, so the impact of specific protocols could not be evaluated. Non-responders may have had higher fear of reinjury, potentially biasing results. The study was conducted in Sweden, so generalizability to other healthcare systems may be limited. The analysis was exploratory and not powered to detect causal relationships or small effects.
Declared interests
The funders (Swedish Medical Research Council, Swedish Research Council for Sport Science, Medical Research Council of Southeast Sweden, Medical Faculty at Linkoping University, National Health and Medical Research Council) played no role in the design, conduct, or reporting of this study.
The easy way to misread this
Do not conclude that surgery causes more fear than rehabilitation alone. The study found similar average fear scores between the two main treatment paths. The higher fear was specifically in patients who initially chose rehabilitation but later underwent surgery, suggesting fear may be a factor in the decision to switch treatments rather than a result of the surgery itself.