A, U or zigzag? Athletes with anterior cruciate ligament reconstruction follow three major psychological patterns: Results from a retrospective evaluation of a local anterior cruciate ligament register

Abstract Purpose Emotional responses during anterior cruciate ligament (ACL) rehabilitation are described as a ‘linear’ or ‘U‐shaped’ pattern, indicating not all athletes exhibit the same emotional pattern. Therefore, this study aimed to (1) identify emotional patterns during the early‐ and mid‐stage phases of rehabilitation after ACL reconstruction (ACLR), and (2) investigate differences in patient‐specific characteristics among these patterns. Methods Patients completed the Photographic Series of Sports Activities for Anterior Cruciate Ligament Reconstruction (PHOSA‐ACLR), and Dutch language short Anterior Cruciate Ligament Return to Sport after Injury scale (short ACL‐RSI‐NL) preoperatively and 6 weeks, 3 months and 6 months postoperatively. Cluster analysis was conducted to identify groups with similar emotional score patterns over time. Changes in scores between consecutive time points (deltas) were calculated for clustering, after which the optimal number of clusters was determined, and K‐means clustering was performed. Results One hundred and twenty‐eight patients completed both surveys at all time points. Patients displayed an ‘A‐shaped’, ‘U‐shaped’ or ‘zigzag’ pattern. Patients with an A‐shaped PHOSA‐ACLR pattern were significantly younger than patients with a zigzag pattern ( p = 0.01). Recreational athletes who are not in competition less often followed an A‐shaped short ACL‐RSI‐NL pattern ( p < 0.002). Patients with an A‐shaped short ACL‐RSI‐NL pattern had significantly higher preoperative scores than patients with a U‐shaped ( p < 0.001) or zigzag pattern ( p < 0.003). Patients with a U‐shaped short ACL‐RSI‐NL pattern had lower scores at six months postoperatively than those with A‐shaped or zigzag patterns. Conclusions Patients' emotions before and after ACLR follow three patterns: ‘A‐shaped’, ‘U‐shaped’, or ‘zigzag’. These patterns are significantly related to age (PHOSA‐ACLR) and level of sport involvement and preoperative readiness to RTS (short ACL‐RSI‐NL). Level of Evidence Level III.