Feasibility of mental skills training during rehabilitation after anterior cruciate ligament reconstruction in young athletes

PURPOSE: Increased psychological stress, decreased psychological readiness and decreased functional outcomes and return to sport are associated with young patients after anterior cruciate ligament (ACL) reconstruction. This study aimed to determine if it would be feasible to institute a mental skills training (MST) program during the post-ACL reconstruction period that would alter the psychological readiness and stress of young athletes. METHODS: Participants were prospectively enrolled pre-ACL reconstruction and received MST from a specialist pre-operatively through 9 months post-operatively. Compliance was measured by the number of sessions attended. A high rate of compliance was used to determine feasibility. ACL-Return to Rport after Injury and PROMIS-Psychological Stress Experiences (PSE) were collected. Outcome measures were compared to a previous matched ACL reconstruction prospective cohort that did not receive MST. RESULTS: Thirty participants (average age: 16.1 [SD ± 2.23], 53% female) were enrolled. 96% of MST sessions were attended and 83% of participants completed all training sessions. The matched cohort included 60 non-MST participants (average age: [15.6 SD ± 2.11], 53% female). The median ACL-return to sports after injury score at 9 months post-op was 78 for the non-MST cohort and 72 for the MST cohort (p = 0.81). There were no significant differences in 6- or 9-month PROMIS-PSE scores. In the MST cohort, the baseline PROMIS-PSE score was 55.7 (±8.23) and at 9 months it was 51.6 (±10.16, p = 0.10). The MST cohort had no significant differences in PROMIS-PSE scores across ages. However, the 6-month ACL-Return to Sport after Injury scores for patients 8-14 and 15-18 were higher compared to patients 19+ (p = 0.02 and p = 0.04, respectively) in the cohort that received MST. No sex differences were detected. CONCLUSIONS: The high rates of participant compliance demonstrate that the implementation of an ACL reconstruction peri-operative MST program is feasible. Further research is needed to determine the efficacy of this kind of program. LEVEL OF EVIDENCE: Level II.