Age and ACL Rehabilitation

Abstract & Commentary

Synopsis: The age of athletes with ACL injury may be an important factor to consider when planning sport-injury rehabilitation programs.

Source: Brewer BW, et al. Age-related differences in predictors of adherence to rehabilitation after anterior cruciate ligament reconstruction. Journal of Athletic Training. 2003;38(2): 158-162.

Brewer and associates sought to determine whether the relationships between psychological factors and rehabilitation adherence after ACL surgery differed as a function of age. Sixty-one subjects with a mean age of 26 (range, 14-47) completed a battery of psychological inventories before ACL reconstruction and recorded their adherence to a home-based accelerated rehabilitation program after surgery. The 4 psychological assessments included: the Self-Motivation Inventory, Social Support Inventory, Athletic Identity Measurement Scale, and Brief Symptom Inventory to assess psychological distress.

Clinic-based rehabilitation adherence was measured by calculating the ratio of appointments attended to appointments scheduled and by the attending rehabilitation professional completing the Sport Injury Rehabilitation Scale. This scale rates the intensity with which the subjects complete exercises, the frequency with which they follow directions and advice, and how receptive they are to rehabilitation program modification. Adherence to home-based rehabilitation was assessed by asking subjects to rate their compliance to prescribed exercises and cryotherapy.

Regression analysis found the following: self-motivation and social support were not significantly related to home exercise completion for younger subjects but were positively associated for older subjects; the relationship between athletic identity and home exercise completion was positive in younger subjects but was not significant for older subjects; and younger subjects had a positive relationship between athletic identity and home cryotherapy completion and older subjects showed no significant relationship between these variables.

Comment by David H. Perrin, PhD, ATC

The most important variables in this study of age-related differences in rehabilitation adherence appear to be self-motivation, social support, and athletic identity as related to home exercise completion. Brewer et al define self-motivation as the tendency to persevere in the absence of external rewards, social support as level of satisfaction with support received in the previous month, and athletic identity as the degree of identity with the athlete role. Self-motivation and social support are more strongly related to adherence in older subjects and athlete identity more positively associated in younger subjects, who consisted primarily of adolescents in this study.

The finding that athlete identity has greater relevance to home exercise adherence in adolescents is not surprising. The 10-item Athletic Identity Measurement Scale examples cited by Brewer et al include "I consider myself an athlete," "Sport is the most important part of my life," and "I feel bad about myself when I do poorly in sport." This scale could be included in a pre-operative workup to help identify adolescent patients who might require closer oversight at home and/or more frequent clinic-based visits during the rehabilitation process.

This study is 1 of 5 comprising a Journal of Athletic Training special section on developmental differences in psychological aspects of sport-injury rehabilitation. The articles collectively illustrate the importance of considering developmental differences in patients during the process of anterior cruciate ligament reconstruction and rehabilitation.

Dr. Perrin is Dean, School of Health and Human Performance, University of North Carolina-Greensboro.