Does fear of re-injury affect the self-perceived level of lower limb functionality among soccer players with ACL reconstruction? A cross-sectional study

The fear of re-injury may persist after anterior cruciate ligament (ACL) reconstruction (ACLR) in professional soccer players (PSPs) even after a successful return to sport (RTS). This study aimed to determine the extent of this fear of re-injury and the impact of demographic variables and this fear of re-injury on the lower extremity functional scale (LEFS) scores in PSPs who had completed a successful RTS following ACLR. A cross-sectional survey design was used. Sixty-seven PSPs who had successfully RTS after ACLR, completed a demographic information sheet, the Athlete Fear-Avoidance Questionnaire (AFAQ), and the LEFS. The average AFAQ scores indicated low fear (M = 10.2, SD = 6.7), while high LEFS scores were observed (M = 67.1, SD = 12.4). There were significant strong negative correlations between LEFS and body mass index (BMI; rs [65] = −0.501, P = .001) and AFAQ and BMI (rs [65] = −0.378, P = .001). A hierarchical linear regression analysis found AFAQ to be a significant predictor of LEFS (b = −0.92, s.e. = 0.19, P = .001), with a total variance (adjusted R²) of 32.9%. PSPs’ fear of re-injury post-ACLR significantly reduced their perceived levels of lower limb functionality. This study highlights the need to further explore and develop strategies to manage PSP fear of re-injury to improve sports-related performance post-ACLR. Abbreviations: ACL = anterior cruciate ligament, ACLR = anterior cruciate ligament reconstruction, AFAQ = athletes’ fear-avoidance questionnaire, LEFS = lower extremity functional scale, PSPs = professional soccer players, RTS = return to sports.