Introduction: The aim of this study is to investigate the relationship between patient psychological characteristics, adherence to rehabilitation physiotherapy and outcome at one year following anterior cruciate ligament reconstruction.

Methods: A group of 57 patients undergoing ACL reconstruction received a pre-operative psychological assessment comprising of five questionnaires; Athletic Identity Measurement Scale (AIMS), Recovery Locus of Control Scale (RLCS), Self-Motivation Inventory (SMI), Hospital Anxiety and Depression Scale (HADS), and Short Form Social Support Questionnaire (SSQ6). Four functional questionnaires were completed pre-operatively by the patient; Subjective Knee Evaluation Form (IKDC 2000), Tegner Activity Scale (TAS), Lysholm Score (LS), and Lower Extremity Functional Score (LEFS). Final outcome was assessed by repeating the functional questionnaires at 1-year post-operatively following rehabilitation. Anterior displacement of the tibia was recorded using a KT1000 arthrometer pre-operatively and at 1 year postoperatively. Adherence to rehabilitation was recorded using the Sport Injury Rehabilitation Adherence Scale (SIRAS) and attendance to physiotherapy appointments.

Results: The data were analysed using regression analysis. Self motivation, a higher athletic identity, good social support and an internal locus of control are all positive predictors of final outcome. Poor self motivation and an external locus of control are associated with less successful final outcome. Rehabilitation adherence is also a positive predictor of final outcome, although psychological factors were not found to be predictive of adherence to rehabilitation.

Discussion and Conclusion: Self motivation and an internal locus of control are positive predictors of adherence to physiotherapy and final outcome. These aspects can be reinforced during rehabilitation. Patients with an external locus of control and poor self-motivation can be identified and their pre- and post-operative management adapted to achieve optimal outcome.


  • Correspondence should be addressed to: BASK c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.