Lower knee self‐efficacy is associated with greater asymmetries in quadriceps neuromuscular function and jump‐landing biomechanics post‐ACL reconstruction
Year: 2025
Type: article
Study design: Observational Study
Abstract: PURPOSE: To (1) compare psychological factors and asymmetries in quadriceps neuromuscular function and jump-landing biomechanics between patients with anterior cruciate ligament reconstruction (ACLR) and healthy controls and (2) determine whether psychological factors relate to these asymmetric outcomes in the ACLR cohort. METHODS: Forty participants (26 patients with ACLR [time since surgery: 39.7 ± 35.1 months] and 14 healthy controls) were included. Psychological assessments included measures of fear of reinjury (Tampa Scale of Kinesiophobia), knee self-efficacy (Knee Self-Efficacy Scale) and readiness for return to sport (anterior cruciate ligament-return to sport after injury). Bilateral quadriceps strength (maximal voluntary isometric contraction) and activation (central activation ratio) were evaluated via a multimodal dynamometer. Bilateral peak knee extension moment (KEM) and peak vertical ground reaction force (vGRF) during jump-landing were assessed using a three-dimensional motion capture system. Limb symmetry indices were calculated for all neuromuscular and biomechanical variables. RESULTS: Compared to healthy controls, patients with ACLR demonstrated significantly worse psychological outcomes (p < 0.001 for all questionnaires; Cohen's d = 1.35-1.94) and greater asymmetries in quadriceps strength (p = 0.016; Cohen's d = 0.84), peak KEM (p < 0.001; Cohen's d = 1.47) and peak vGRF (p = 0.002; Cohen's d = 1.10). Among patients with ACLR, lower knee self-efficacy was moderately to strongly associated with greater asymmetries across all neuromuscular and biomechanical measures (ρ = 0.420-0.737; p ≤ 0.033). Greater fear of reinjury (r = -0.403; p = 0.041) and lower readiness for return to sport (r = 0.522; p = 0.006) were moderately associated with greater asymmetry in peak vGRF. CONCLUSION: Patients with ACLR displayed worse psychological outcomes and greater asymmetries in quadriceps neuromuscular function and jump-landing biomechanics compared to healthy controls. Knee self-efficacy was consistently associated with asymmetries in quadriceps neuromuscular function and jump-landing biomechanics following ACLR. Asymmetry in vGRF may be particularly sensitive to psychological factors in patients with ACLR. LEVEL OF EVIDENCE: Level III.
DOI: 10.1002/ksa.70192
Authors: Sungwan Kim, Julie P. Burland
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4416230439