Characterizing Injury-Related Fear in Patients after Anterior Cruciate Ligament Reconstruction

Injury-related fear after anterior cruciate ligament (ACL) injury significantly contributes to decreased
return to sport, decreased physical activity engagement, and increased secondary ACL injury in previously high
functioning, physically active individuals. Injury-related fear is also associated with poor jump-landing movement
patterns and worse self-reported knee function in patients after ACL reconstruction (ACLR). While injury-related
fear can be modified using psychological interventions, we have not comprehensively characterized how, when,
and what types of injury-related fears (e.g., fear of movement, reinjury, avoidance) impede recovery.
Furthermore, there is limited evidence regarding patient perceptions of injury-related fear and their perceived
consequences on recovery outcomes. Failure to identify what types and when these fears are present throughout
ACLR rehabilitation, and how patients perceive these fears to impact their recovery, will significantly inhibit our
ability to effectively intervene with robust and effective psychological interventions aimed to mitigate secondary
ACL injury risk. We hypothesize that patients follow three separate trajectories, including favorable (i.e.,
decreases in fear that are maintained), unfavorable (i.e., unresolved fear at clearance for return for activity), and
variable trajectories (i.e., decreases in fear likely due to direct intervention prior to return to activity). Identifying
these trajectories will enhance intervention effectiveness for future clinical trials using psychological interventions
to mitigate secondary ACL injury risk and improve long-term knee joint health. Consequently, there is a critical
need for high-quality longitudinal studies to characterize injury-related fear, both quantitatively and qualitatively,
in patients after ACLR. Therefore, the objective of this study is to characterize injury-related fear in patients
post-ACLR. A total of 50 patients will complete surveys to assess injury-related fear at important clinical
timepoints, including pre-operatively, and at 2-, 4-, 6-, and 9-months post-ACLR. A subset of 15 patients at 9-
months post-ACLR will complete semi-structured interviews to identify patient perceived impacts of injury-related
fear on recovery outcomes and discuss interventions that could be used to reduce injury-related fear after ACLR.
The central hypothesis is that multiple trajectories will exist for injury-related fears (i.e., fear of movement, fear
of reinjury, and fear-avoidance beliefs) which will be supported qualitatively through patient interviews. The
findings from this proposal will address a gap in knowledge by providing a clear understanding of how injury-
related fear changes over time in patients after ACLR. This proposal will also position an aspiring independent
clinician scientist with pertinent data that is needed to support future NIH grant applications and the trajectory of
her independent research career.

Grant Number: 1R03AR085215-01
NIH Institute/Center: NIH
Principal Investigator: Shelby Baez