Patients' Mental Barriers in Rehabilitation after ACL Reconstruction: A Qualitative Interview Study.
Ingunn Fleten Mo, Nicky van Melick, Trine Hysing-Dahl and 5 others
PMID 42694019WHAT IT FOUND
Nine patients 5–9 months post-ACL surgery describe readiness as a shifting process, not a fixed milestone.
Their physical therapist is the main psychological anchor, yet they don't recognise that support as psychological. Ask about fear and confidence, not just strength.
Key findings
01Patients experienced psychological readiness as a fluctuating process shaped by physical progress, setbacks, and the therapeutic relationship, rather than as a single checkpoint to be passed.
02Physical therapists were described as the central source of emotional support during rehabilitation, providing structure, reassurance, and gradual exposure; however, patients often did not recognise this as psychological support and experienced it simply as part of their physical rehab.
03Fear of re-injury, uncertainty about knee stability, and frustration from setbacks or testing failures were the most prominent mental barriers, particularly early in rehabilitation or when progress stalled.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Nine patients is a small sample; the themes reflect these individuals' experiences and cannot be generalised to all ACLR patients. All participants were aiming to return to a pivoting sport, so the findings may not apply to patients with recreational goals, non-pivoting sport goals, or those not planning to return to sport at all. All were interviewed at a single time window (5–9 months post-surgery); earlier or later phases of rehabilitation are not represented. The interview guide was translated into Dutch and Norwegian without formal back-translation, and translated quotations were not independently checked by a second bilingual researcher, which may have affected nuance. One patient had been operated on by a study author, although that author did not conduct or attend the interview. The study did not test any intervention or measure return-to-sport outcomes; the authors themselves note the implications should be read as hypotheses for practice, not evidence of effectiveness. Patients were asked to recall earlier phases of rehabilitation (preoperative, early postoperative), introducing some recall bias, though the authors judged this minimal because the memories were vivid and emotionally significant.
Declared interests
The authors report no conflicts of interest. The study was funded by the Dutch Arthroscopy Society (NVA) with €10,000, used to compensate patients for travel costs (parking and fuel) and to cover open-access publishing of the article.
The easy way to misread this
Do not read these themes as evidence that a specific psychological intervention or a particular PT communication style improves return-to-sport outcomes. The study interviewed nine patients and did not test any intervention, compare groups, or measure a return-to-sport endpoint. The authors themselves state that the practical implications should be interpreted as hypotheses for future research rather than evidence of effectiveness. Additionally, all participants were aiming to return to a pivoting sport, so the findings may not transfer to patients with different goals or at different stages of recovery.