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. 2025 Feb 19;13(2):23259671241301376.
doi: 10.1177/23259671241301376. eCollection 2025 Feb.

Investigating the Impact of Preoperative Kinesiophobia and Pain on Postoperative Gait Biomechanics Following Anterior Cruciate Ligament Injury

Caroline Lisee  1 , Shelby Baez  2 , Elizabeth Bjornsen  2 , Louise Thoma  3 , Troy Blackburn  2 , Jeffrey T Spang  4 , R Alexander Creighton  4 , Ganesh Kamath  4 , Jessica Hu  5 , Brian Pietrosimone  2   4
Affiliations

Investigating the Impact of Preoperative Kinesiophobia and Pain on Postoperative Gait Biomechanics Following Anterior Cruciate Ligament Injury

Caroline Lisee et al. Orthop J Sports Med. .

Abstract

Background: Aberrant gait biomechanics-ie, lower knee abduction moment (KAM) impulse- are linked to the development of posttraumatic osteoarthritis after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR). There is a clinical need to identify modifiable factors, such as kinesiophobia and pain, that may contribute to aberrant gait development after ACLR to advance multimodal rehabilitation strategies.

Purpose/hypothesis: This study aimed to determine associations between preoperative kinesiophobia and pain and gait biomechanics linked to posttraumatic osteoarthritis development at 2 and 4 months after ACLR. We hypothesized that worse preoperative kinesiophobia and pain would be associated with lower KAM impulses in the ACLR limb but not the uninjured limb at 2 and 4 months after ACLR.

Study design: Cohort study; Level of evidence, 2.

Methods: Patients within 6 weeks of ACL injury and planning to undergo ACLR with bone-patellar tendon-bone autografts were recruited for the study. Preoperatively, participants completed the Tampa Scale of Kinesiophobia (TSK-11) and Knee injury and Osteoarthritis Outcome Score Pain (KOOS Pain) subscale surveys to assess kinesiophobia (ie, psychological component to pain) and knee pain, respectively. Participants returned at 2 and 4 months after ACLR to complete a 3-dimensional gait biomechanics analysis. KAM impulses during the stance phase were calculated (N*m*s/N*m) for both limbs. Associations of preoperative TSK-11 and KOOS Pain scores with KAM impulses in ACLR and uninjured limbs were analyzed using separate linear regressions.

Results: A total of 36 participants (58% women; mean age, 21.4 ± 4.31 years; body mass index, 24.1 ± 3.59 kg/m2 ) completed 3 study visits. Higher preoperative kinesiophobia was associated with lower KAM impulses in the ACLR limb (R 2 = 0.14; P = .02) but not the uninjured limb (R 2 = 0.01; P = .58) at 4 months after ACLR. Preoperative KOOS Pain scores were not associated with KAM impulses in the ACLR and uninjured limbs at 2 and 4 months after ACLR (ΔR 2 range, <0.01-0.02; P range = .53-.90).

Conclusion: Preoperative kinesiophobia, but not pain, was weakly associated with lower KAM impulses during early to midphases of clinical recovery at 4 months after ACLR.

Keywords: anterior cruciate ligament; knee; motion analysis/kinesiology; physical therapy/rehabilitation.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: Research support was received from the Arthritis Foundation. J.T.S. has received education payments from Southtech Orthopedics. G.K. has received nonconsulting fees from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from The University of North Carolina at Chapel Hill (20-2227).

Figures

Figure 1.
Figure 1.
A STROBE flowchart describing participant recruitment, enrollment, follow-up, and analysis. ACLR, anterior cruciate ligament reconstruction; Preop, preoperatively; STROBE, Strengthening the Reporting of Observational Studies in Epidemiology.
Appendix Figure A1.
Appendix Figure A1.
Comparisons in KAM impulse (N*m*s/N*m) between the ACLR (grey) and uninjured limbs (white) at 2 (left panel) and 4 months (right panel) after ACLR. Half-violin plots depict the distribution of the KAM impulse outcomes in each limb at both time points. Box plots depict the median values (center line) and the interquartile range (top/bottom of the box) of the KAM impulse outcomes. *Indicates statistically significant differences between limbs. ACLR, anterior cruciate ligament reconstruction; KAM, knee abduction moment.
See this image and copyright information in PMC

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