Self-Identity and Adolescent Return to Sports Post-ACL Injury and Rehabilitation: Will Anyone Listen?

Psychological recovery following anterior cruciate ligament (ACL) injury, surgery, and rehabilitation may be influenced by concerns related to self-identity, self-esteem, self-efficacy, health locus of control, fear/avoidance, kinesiophobia, depression, and other emotional or behavioral factors. Through clinical practice guidelines and consensus position articles, knee surgeons, physical therapists, and athletic trainers have greatly improved the process by which physiological musculoskeletal impairment and functional limitation achievement goals translate into evidence-based return to unrestricted sports participation decisions. However, the key psychological indicators or milestones that represent safe return to sports readiness remains poorly understood. The International Classification of Functioning, Disability and Health Model (ICF) provides a helpful framework for generating a more comprehensive decision-making evaluation. The ICF considers patient function as the dynamic interaction between health conditions, environmental factors, and personal factors. Through the use of its common language, the ICF encourages interdisciplinary health care provider communication to more effectively implement team-based, patient-centered care, to better integrate physiological and psychological evaluation and treatment expertise into comprehensive care plans. This article describes the influence of high athletic self-identity on return to sports decision-making among adolescent athletes following ACL injury, surgery, and rehabilitation. Information about adolescence, sports, sports specialization, athletic identity, and more comprehensive return to play decision-making are synthesized into recommendations designed to reduce knee reinjury or new injury risk, and to improve performance among this patient population.