title: Fear of reinjury (kinesiophobia) and persistent knee symptoms are common factors for lack of return to sport after anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  Our purpose was to determine patient-cited reasons for lack of return to sport after anterior cruciate ligament reconstruction.
  
  
  METHODS
  All patients who underwent primary or revision anterior cruciate ligament reconstruction by 2 surgeons from 2007 to 2008 (N = 171) were contacted for a telephone interview. Patients who did not return to preinjury levels by self-assessment were then asked to cite contributing factors from a predetermined list. These included non-knee-related life events, persistent knee symptoms, fear of reinjury (kinesiophobia), and choice-related options (such as lack of interest or time).
  
  
  RESULTS
  Of the 135 patients who completed the interview, 62 (46%) reported a return to preinjury activity levels (returners) whereas 73 (54%) did not (non-returners). Returners (26.4 ± 10.9 years) were younger than non-returners (30.0 ± 9.8 years) (P = .04). Persistent knee symptoms (68%) and kinesiophobia (52%) were more commonly cited as reasons for not returning to sport than non-knee-related life events (29%), including children, job/education, or health problems (P < .001 for symptoms and P = .004 for kinesiophobia). Among non-returners who cited knee symptoms, 50% concurrently cited kinesiophobia and 24% cited life events.
  
  
  CONCLUSIONS
  A lack of return to preinjury activity levels is common after anterior cruciate ligament reconstruction. A majority of patients who do not return to their preinjury activities cite persistent knee symptoms, particularly pain, as a contributing factor, and only a minority of patients cite job and family demands or a lack of interest. Finally, fear of reinjury was cited by half of the patients who did not return to sport.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: Sports Health and Performance Institute, Columbus, Ohio, USA. david.flanigan@osumc.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Flanigan
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Everhart
authors.forename: Angela
authors.initials: A
authors.lastname: Pedroza
authors.forename: Tyler
authors.initials: T
authors.lastname: Smith
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Kaeding
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000523:psychology*; D001294:Attitude to Health; D003163:Competitive Behavior; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000523:psychology* / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012086:Reoperation; D012189:Retrospective Studies; D055502:Secondary Prevention; D013177:Sports / Q000145:classification / Q000523:psychology*; D055815:Young Adult