Enhanced Self-Efficacy and Sports Return in Pediatric vs. Older ACL Patients

Overview

This study evaluated rehabilitation outcomes after ACL reconstruction in pediatric, adolescent, and young adult patients, focusing on muscle function, self-efficacy, and return to sport (RTS). Pediatric patients demonstrated higher knee-related self-efficacy, psychological readiness, and greater rates of RTS at 8 and 12 months post-surgery compared to adolescents and young adults.

Background

Anterior cruciate ligament (ACL) reconstruction is common in young athletes, but early return to sport is linked to increased risk of graft rupture and contralateral injury. Adolescents often return to sport earlier than young adults despite incomplete functional recovery and have a higher risk of second ACL injuries. Symmetrical muscle function is a key protective factor against reinjury, yet few younger athletes achieve this before RTS. Understanding age-related differences in rehabilitation outcomes, including psychological factors and muscle function, is crucial for optimizing recovery and reducing injury risk.

Data Highlights

Key Findings

• Pediatric patients showed significantly higher knee-related self-efficacy (K-SES) scores compared to adolescents and young adults at 8 and 12 months post-ACL reconstruction.
• Psychological readiness to return to sport (measured by ACL-RSI) was greater in pediatric patients than in older groups during early follow-ups.
• Return to sport rates at 8 and 12 months were higher in pediatric patients compared to adolescents and young adults.
• Adolescents tended to return to knee-strenuous sports earlier than young adults despite not achieving symmetrical muscle function.
• Symmetrical muscle function, assessed by hop and strength tests, was less frequently achieved in younger patients before RTS, especially adolescents.
• Age at time of ACL reconstruction was associated with risk of not achieving symmetrical muscle function within two years post-surgery.

Clinical Implications

Clinicians should consider age-specific psychological and functional recovery profiles when planning rehabilitation and RTS timelines after ACL reconstruction. Enhanced self-efficacy and psychological preparedness in pediatric patients may support safer and more successful RTS. Adolescents require careful monitoring to ensure adequate muscle function recovery before RTS to reduce reinjury risk. Tailored rehabilitation protocols emphasizing both physical and psychological readiness are essential across age groups.

Conclusion

Pediatric patients demonstrate superior psychological readiness and higher return to sport rates early after ACL reconstruction compared to adolescents and young adults, who often return prematurely without full muscle recovery. Age-specific rehabilitation strategies are critical to optimize outcomes and minimize reinjury risk.

References

1. Project ACL/Swedish Ethical Review Authority/2020 -- Rehabilitation outcome registry and ethical approval
2. Kvist J et al./2006 -- Knee Self-Efficacy Scale (K-SES) development
3. Webster KE et al./2018 -- ACL Return to Sport after Injury scale (ACL-RSI) validation
4. Tegner Y & Lysholm J/1985 -- Tegner Activity Scale validation