Fear-avoidance beliefs and health-related quality of life in post-ACL reconstruction and healthy athletes: A case-control study

Context: Many athletes return to sport after anterior cruciate ligament reconstruction (ACLR) with lingering physical or mental health impairments. Examining health-related quality of life (HRQL) and fear-avoidance beliefs across the spectrum of noninjured athletes and athletes with a history of ACLR may provide further insight into targeted therapies warranted for this population. Objective: The purpose of this study was to examine differences in fear-avoidance beliefs and HRQL in college athletes with a history of ACLR not participating in sport (ACLR-NPS), participating in sport (ACLR-PS), and healthy controls (Control) with no history of injury participating in sport. Design: Cross-sectional. Setting: Laboratory. Patients (or Other Participants): A total of 10 college athletes per group (ACLR-NPS, ACLR-PS, and Control) were included. Participants were included if on a roster of a Division I or III athletic team during data collection. Interventions: Participants completed a demographic survey, the modified Disablement in the Physically Active Scale (mDPA) to assess HRQL, and Fear-Avoidance Beliefs Questionnaire (FABQ) to assess fear-avoidance beliefs. Main Outcome Measures: Scores on the mDPA (Physical and Mental) and FABQ subscales (Sport and Physical Activity) were calculated, a 1-way Kruskal-Wallis test and separate Mann-Whitney U post hoc tests were performed (P <.05). Results: ACLR-NPS (30.00 [26.00]) had higher FABQ-Sport scores than ACLR-PS (18.00 [26.00]; P <.001) and Controls (0.00 [2.50]; P <.001). ACLR-NPS (21.50 [6.25]) had higher FABQ-Physical Activity scores than ACLR-PS (12.50 [13.00]; P =.001) and Controls (0.00 [1.00]; P <.001). Interestingly, ACLR-PS scores for FABQ-Sport (P =.01) and FABQ-Physical Activity (P =.04) were elevated compared with Controls. ACLR-NPS had higher scores on the mDPA-Physical compared with the ACLR-PS (P <.001) and Controls (P <.001), and mDPA-Mental compared with ACLR-PS (P =.01), indicating decreased HRQL. Conclusions: The ACLR-NPS had greater fear-avoidance beliefs and lower HRQL compared with ACLR-PS and Controls. However, the ACLR-PS had higher scores for both FABQ subscales compared with Controls. These findings support the need for additional psychosocial therapies to address fear-avoidance beliefs in the returned to sport population.