Given how many college and professional athletes undergo ACL reconstruction and return to sports, you might be surprised that return to sports is far from guaranteed. A 2006 American Journal of Sports Medicine study showed that 21% of NFL players never return to play after Exam of female patient kneeACL injury. A 2010 study published in that same journal showed more discouraging numbers, with only 63% of professional football players returning to the sport.

Stiffness of the knee, continued instability and other physical factors can certainly impact success rates after ACL reconstruction. Evidence is mounting that psychological issues could play a large role in the struggles many athletes face, especially competitive athletes.

A new article recently published in the Journal of the American Academy of Orthopaedic Surgeons dives into some of the psychological aspects of ACL recovery. Melissa A. Christino, M.D. and others offer insight directed towards the orthopedic surgeons who perform the procedures and follow the athletes after surgery. Their information, as well as some questions to ask injured athletes, might be just as helpful for parents, coaches, friends and teammates of athletes who suffer an ACL tear to recognize signs of trouble.

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Dr. Christino and the other authors describe many psychological issues that can affect athletes who suffer sports injuries, especially significant ones like ACL injuries.

  • Injured athletes can battle emotional issues such as depression, anger and low self-esteem.
  • The injury and time out of sports can impair an athlete’s sense of self-worth and identity, which is often based largely on his or her sports career and performance.
  • Adolescent patients might have an even higher risk of anxiety, mood disturbance, and pain intolerance after ACL injury than older patients.
  • Athletes who believe that their actions affect outcomes and that they control their ability to succeed (higher self-efficacy) might have improved outcomes after surgery.

Dr. Christino concludes with several questions that orthopedic surgeons can ask patients during postoperative appointments to assess their psychological state during their rehab and recovery from ACL reconstruction. Orthopedic surgeons are not trained to evaluate or treat mental health concerns, but the patient’s responses to these questions could help indicate an athlete who is struggling emotionally.

Among the questions that could identify psychological issues after ACL reconstruction are:

  • How are you feeling about yourself at this point in your recovery?
  • How have you been dealing with your injury/recovery from an emotional standpoint?
  • Do you feel sad or depressed about your injury/recovery?
  • Have you been able to stay involved with your team and teammates?
  • Do you feel that you are able to control how well you will do with your rehabilitation?Athlete holding knee
  • Do you think you have the mental and physical skills needed to get better?

I think these and similar questions could actually help everyone closely involved with an injured athlete. An athletic trainer who works with an injured soccer player two or three days per week could ask these questions and gauge her emotional state. A physical therapist could use her answers to understand why her measurements in physical therapy may lag behind what is expected. The coach might recognize that she is struggling being away from the team and encourage her to coach drills during practices. A parent might recognize depression and point it out to the orthopedic surgeon.

Also read:
When is an athlete ready for sports after ACL surgery?
Can “prehab” improve outcomes after ACL surgery?
3 less known reasons athletes don’t return after ACL injuries

If we can recognize that an injured athlete is struggling after ACL surgery, we can utilize the services of a sports psychologist or another mental health professional. A team approach that focuses not just on the physical recovery but also the psychological side might improve our ability to get athletes back to play.

Christino MA, Fantry AJ, Vopat BG. Psychological Aspects of Recovery Following Anterior Cruciate Ligament Reconstruction. J Am Acad Orthop Surg. 2015 Aug;23(8):501-9.