Psychological readiness after ACL reconstruction should be viewed as an evolving component of recovery shaped by patients' experiences, support systems, and interactions with physiotherapists, highlighting the importance of a holistic and individualized rehabilitation approach.
Key Findings
Results
Three overarching themes emerged from patient interviews describing psychological barriers and facilitators during ACLR rehabilitation.
Theme 1: 'The Mental Landscape of Rehabilitation' — confidence builds through physical progress amidst emotional setbacks
Theme 2: 'Pillars of Support' — professional and social support, especially from physiotherapists, helps manage fear and build trust
Theme 3: 'Lessons Learned Along the Way' — patients develop insight, resilience, and personalized strategies for mental recovery
Data were analyzed using systematic text condensation methodology
Results
Psychological readiness for return to sport was experienced by patients as a dynamic, evolving process rather than a fixed state.
Readiness was shaped by physical progress, emotional responses, support systems, and interactions with physiotherapists
Participants were 5–9 months post-ACLR at the time of interview, capturing a range of rehabilitation stages
Nine patients (5 women, 4 men), aged 19–45 years, from Norway and the Netherlands participated
Individual semi-structured interviews were used to capture subjective rehabilitation experiences
Results
Physiotherapists played a central role in helping patients manage fear and build psychological confidence during rehabilitation.
PT interactions were identified as a key component of the 'Pillars of Support' theme
PTs helped patients manage fear and build trust as part of the support structure
Both professional support (PTs) and social support were identified as important pillars
The findings highlight the importance of a holistic and individualized rehabilitation approach that acknowledges mental barriers and supports confidence-building
Results
Patients reported developing insight, resilience, and personalized coping strategies for mental recovery over the course of rehabilitation.
This was captured under the theme 'Lessons Learned Along the Way'
Patients developed individualized strategies rather than uniform approaches to mental recovery
The study recruited patients from two countries (Norway and the Netherlands) to capture diverse rehabilitation contexts
Conclusions
The authors conclude that referral to mental health professionals should be considered as part of ACLR rehabilitation when needed.
Findings highlight that psychological barriers are sufficiently significant to warrant mental health referral in some cases
A holistic and individualized rehabilitation approach is recommended that acknowledges mental barriers
Psychological readiness is positioned as an evolving component of recovery, not a binary outcome
This recommendation emerged from qualitative data representing Level of Evidence 5
Background
Less is known about how patients subjectively experience psychological barriers during ACLR rehabilitation and how physiotherapist interactions shape this process, which motivated the study.
While psychological readiness for return to sport is increasingly recognized as important, the patient experience perspective was identified as a gap
The study purpose was to explore how patients navigate potential psychological barriers, what helps them overcome these barriers, and how they experience the role of PTs
A qualitative design was chosen to address this experiential gap in the literature
What This Means
This research suggests that recovering from ACL knee surgery is not just a physical challenge — it is also deeply psychological. Through in-depth interviews with nine patients (five women and four men, aged 19–45) who were between five and nine months after their surgery, researchers identified three main themes: the emotional ups and downs that accompany physical recovery, the importance of support from both physiotherapists and social networks, and the personal coping strategies and resilience patients develop over time. Importantly, patients described their psychological readiness to return to sport as something that shifted and evolved throughout rehabilitation rather than something they either had or didn't have.
One of the study's key insights is the central role that physiotherapists play — not just in guiding physical exercises, but in helping patients manage fear, build trust, and feel more confident. Patients also reported learning from their experiences and developing personalized mental strategies to cope with setbacks. The researchers suggest that rehabilitation programs should be individualized and holistic, taking mental barriers seriously alongside physical ones.
This research matters because it gives a patient-centered view of what ACL rehabilitation actually feels like from the inside. It suggests that healthcare providers should proactively address the psychological side of recovery and consider referring patients to mental health professionals when emotional challenges become significant. While this was a small qualitative study, the richness of the patient experiences described provides practical guidance for physiotherapists aiming to support the full — physical and mental — recovery of their patients.
Ingunn Fleten Mo, Nicky van Melick, T. Hysing-Dahl, L. Magnussen, Per-Henrik Randsborg, Rob Bogie, et al.. (2026). Patients’ Mental Barriers in Rehabilitation after ACL Reconstruction: A Qualitative Interview Study. International Journal of Sports Physical Therapy. https://doi.org/10.26603/001c.167447