Beyond the Physical

Despite advancements in physical rehabilitation after ACL reconstruction (ACLR), many athletes struggle with psychological barriers to returning to sport. This mixed-methods study examined (1) the prevalence of fear of reinjury and psychological readiness in post-ACLR athletes and (2) the lived experiences influencing their recovery. Quantitative data were collected from 50 athletes (simulated dataset) using the ACL-Return to Sport After Injury scale (ACL-RSI) and the Tampa Scale of Kinesiophobia (TSK). Qualitative data included in-depth interviews (simulated responses from 10 athletes) exploring emotional challenges during rehabilitation. Quantitative analysis revealed that 40% of athletes scored below 50 on the ACL-RSI (indicating low readiness), with a significant negative correlation between TSK scores and return-to-sport status (r = -0.45, p < 0.01). Thematic analysis of interviews identified three key psychological barriers: (1) fear of reinjury (“I’m terrified my knee will give out again”), (2) distrust in the surgically repaired knee (“It doesn’t feel like mine anymore”), and (3) external pressure (“My coach expects me to perform like before”).

Conclusion: Fear of reinjury and low psychological readiness are prevalent among post-ACLR athletes, with qualitative insights highlighting the need for integrated mental health support in rehabilitation programs. Clinicians should adopt a biopsychosocial approach to address these barriers and improve return-to-sport outcomes.

Keywords: ACL rehabilitation, fear of reinjury, psychological readiness, mixed-methods, return to sport