Psychological, physical, and social factors associated with psychological readiness for return to sport following revision anterior cruciate ligament reconstruction

Abstract

Return to competitive sporting activity following revision anterior cruciate ligament reconstruction (ACLR) remains inconsistent and is influenced by several interacting factors. Beyond graft integrity and knee stability, psychological and social factors may contribute to a successful return to sport (RTS). This study evaluated factors associated with psychological readiness for RTS after revision ACLR. Ninety-eight patients who underwent revision ACLR with a bone–patellar tendon–bone autograft were prospectively evaluated. Knee-related functional recovery was quantified using the International Knee Documentation Committee, Lysholm, and Tegner assessment tools, while psychological adaptation toward athletic reintegration was examined using the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scale. RTS status and patient-reported psychological and social influences were observed over 5 years. A single-stage reconstructive strategy was utilized for 81 patients (82.7%), whereas 17 (17.3%) required a two-stage revision ACLR protocol. The Lysholm score improved significantly from 45.83 ± 7.9 preoperatively to 88.4 ± 6.4 postoperatively ( p < 0.001). No graft failures occurred. Overall, 75 patients (76.5%) returned to sport; 44 (58.6%) regained their pre-injury level, whereas 31 (41.3%) returned at a lower level. Apprehension regarding reinjury (79.6%) emerged as the predominant obstacle preventing successful RTS, followed by persistent knee symptoms and peer influence. Higher functional and ACL-RSI scores were associated with successful RTS. RTS following revision ACLR is influenced not only by functional recovery but also by psychological readiness and social factors.