Greater Psychological Readiness to Return to Sport, as Well as Greater Present and Future Knee‐Related Self‐Efficacy, Can Increase the Risk for an Anterior Cruciate Ligament Re‐Rupture: A Matched Cohort Study

PURPOSE: To determine the psychological characteristics and strength outcomes of patients who sustained an early anterior cruciate ligament (ACL) re-rupture after their primary ACL reconstruction and cross-sectionally compare them with a matched cohort of patients who did not sustain a reinjury during the first 2 years after primary ACL reconstruction. METHODS: In this matched cohort study, data for quadriceps and hamstring strength and 3 hop tests and answers to standardized patient-reported outcomes (the Anterior Cruciate Ligament Return to Sport after Injury scale and a short version of the Knee Self-Efficacy Scale) were extracted from a rehabilitation outcome registry. Data for patients suffering a re-rupture were extracted, and patients were matched in terms of sex, age, and activity level with patients not suffering an ACL re-rupture within 2 years of primary reconstruction. The groups were compared 10 weeks and 4, 8, and 12 months after the primary reconstruction. RESULTS: A total of 36 patients suffering an ACL re-rupture were matched with 108 patients not suffering a re-rupture after ACL reconstruction. Patients who suffered an ACL re-rupture had greater psychological readiness, that is, greater confidence in performance, lesser negative emotions, and lesser risk appraisal, to return to sport (RTS) at 8 months (81. 2 vs 67. 9 95% Δconfidence interval CI 2. 7-23. 8) P =. 014) and at 12 months (95. 2 vs 67. 1, (95% ΔCI 14. 3-41. 8) P ≤. 001), and greater knee-related self-efficacy at 8 months (8. 6 vs 8. 0 [95% ΔCI 0. 1-1. 2, P =. 021) and 12 months (9. 4 vs 8. 1, 95% ΔCI 0. 3-2. 2 P =. 012) after primary ACL reconstruction, compared with the matched group. CONCLUSIONS: A stronger psychological profile, defined by a greater psychological readiness to RTS and knee-related self-efficacy, may be associated with an ACL re-rupture within 2 years of the primary reconstruction. LEVEL OF EVIDENCE: Matched cohort study, level III.