Effectiveness of psychological intervention following anterior cruciate ligament reconstruction: A systematic review and meta-analysis

• Published in: Physical therapy in sport 2024-09, Vol.69, p.40-50
• Main Authors: Isaji, Yuichi, Uchino, Shota, Inada, Ryuta, Saito, Hiroki
• Format: Article
• Language: English
• Subjects: ACLR; Anterior Cruciate Ligament Injuries - rehabilitation; Anterior Cruciate Ligament Injuries - surgery; Anterior Cruciate Ligament Reconstruction - rehabilitation; Bias; Humans; Intervention; Joint and ligament injuries; Kinesiophobia; Knee; Meta-analysis; Muscle strength; Pain; Physical therapy; Prospero trial registry number CRD42022331062; Psychological factor; Psychological intervention; Psychosocial Intervention; Quality standards; Range of motion; Rehabilitation; Sports injuries; Systematic review
• ISSN: 1466-853X; 1873-1600; 1873-1600
• DOI: 10.1016/j.ptsp.2024.07.003

To determine the effectiveness of psychological interventions in postoperative anterior cruciate ligament reconstruction (ACLR) compared to standard rehabilitation. The databases searched were PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, PEDro, Cumulative Index to Nursing & Allied Health Literature, and EMBASE were searched from each database inception to May 2023 for published studies. The methodological quality was assessed with the Cochrane Risk of Bias Assessment (RoB 2.0) tool. The evidence quality was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Six papers were included in the meta-analysis. Psychological intervention significantly improved Tampa Scale for Kinesiophobia at 3 months (Standard Mean Difference [SMD], −0.51. 95% Confidence Interval [CI], −0.85 to −0.17) and pain (Knee Injury and Osteoarthritis Outcome Score for Pain, Numeric Rating Scale, Visual Analog Scale) at 3 months (SMD, −0.92. 95%CI, −1.69 to −0.15) and at 6 months following ACLR (MD, −1.25. 95%CI, −1.82 to −0.68) when compared with the standard rehabilitation, according to very low-quality data. Self-efficacy and knee strength did not show significant differences. Very low-quality evidence suggests that psychological intervention following ACLR yields better short-term outcomes compared to standard rehabilitation, with uncertainty about its clinically significant benefits over standard rehabilitation. •Psychological problems in ACLR patients are considered a major issue in return to sports.•A systematic review compared the intervention effects of psychological and standard rehabilitation interventions.•The quality of the evidence was very low.•Psychological intervention significantly improved TSK at 3 months and pain at 3 months at 6 months following ACLR.•There is uncertainty about its clinically significant benefits over standard rehabilitation.