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So you think you can return to sport?
  1. Trevor A Lentz1,
  2. Mark V Paterno2,3,
  3. Jonathan C Riboh4
  1. 1 Duke Clinical Research Institute, Durham, North Carolina, USA
  2. 2 Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
  3. 3 Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
  4. 4 Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
  1. Correspondence to Dr Trevor A Lentz, Duke Clinical Research Institute, Durham, NC 27705, USA; trevor.lentz{at}

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‘Within the next two years, you will have another ACL tear’. This statement is true for one out of every three young athletes who undergo ACL reconstruction and return to cutting and pivoting sports.1 2 Understandably, this high rate of reinjury has led to questions about the effectiveness of current rehabilitation programmes and return-to-sport decision-making tools. In this editorial, we suggest psychological readiness for return to sport as a contributing, yet overlooked risk factor for reinjury in young athletes.

The duality of psychological readiness

Psychological readiness for return to sport has been associated with the ability to achieve preinjury levels of sports participation following surgery.3 However, characteristics of psychological readiness, like self-efficacy (ie, confidence) and fear of reinjury, might be equally important indicators for risk of reinjury, although for very different reasons. The fear avoidance model has been applied to postoperative recovery following ACL reconstruction to describe how high fear of reinjury and low self-efficacy can lead to poor function.4 But this model also describes a mechanism where low fear and high self-efficacy can facilitate …

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  • Contributors All authors contributed to the development, writing, review and final approval of the editorial.

  • Funding This study was funded by the Foundation for Physical Therapy (PODS I and II).

  • Competing interests JCR is a paid consultant for Ceterix Orthopaedics, a company that manufactures meniscal repair systems. This relationship may not be relevant to this editorial, but is being disclosed for transparency.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.