Association between kinesiophobia and walking gait characteristics in physically active individuals with anterior cruciate ligament reconstruction

Background: Individuals with anterior cruciate ligament reconstruction (ACLR) demonstrate persistent alterations in walking gait characteristics that contribute to poor long-term outcomes. Higher kinesiophobia, or fear of movement/re-injury, may result in the avoidance of movements that increase loading on the ACLR limb. Research Question: Determine the association between kinesiophobia and walking gait characteristics in physically active individuals with ACLR. Methods: We enrolled thirty participants with a history of unilateral ACLR (49.35 +/- 27.29 months following ACLR) into this cross-sectional study. We used the Tampa Scale for Kinesiophobia (TSK-11) to measure kinesiophobia. We collected walking gait characteristics during a 60-s walking trial, which included gait speed, peak vertical ground reaction force (vGRF), instantaneous vGRF loading rate, peak internal knee extension moment (KEM), and knee flexion excursion. We calculated lower extremity kinetic and kinematic measures on the ACLR limb, and limb symmetry indices between ACLR and contralateral limbs (LSI= [ACLR/contralateral]*100). We used linear regression models to determine the association between TSK-11 score and each walking gait characteristic. We determined the change in R-2 (Delta R-2) when adding TSK-11 scores into the linear regression model after accounting for demographic covariates (sex, Tegner activity score, graft type, time since reconstruction, history of concomitant meniscal procedure). Results: We did not find a significant association between kinesiophobia and self-selected gait speed (Delta R-2 0.038, P = 0.319). Kinesiophobia demonstrated weak, non-significant associations with kinetic and kinematic outcomes on the ACLR limb and all LSI outcomes (Delta R-2 range = 0.001-0.098). Significance: These data do not support that kinesiophobia is a critical factor contributing to walking gait characteristics in physically active individuals with ACLR.