🎯 Título: Preparación psicológica: atletas de élite vs. no élite tras cirugía de LCA
📌 En breve: Aunque los atletas de élite tuvieron mejores puntajes psicológicos y más retorno al deporte tras la reconstrucción de LCA, ser élite no fue, por sí solo, un predictor independiente de esa preparación psicológica.
🔬 Puntos clave:
### El estudio
Estudio de cohorte con 756 participantes (252 atletas de élite y 504 no élite, emparejados por puntaje de propensión), que comparó la preparación psicológica mediante la escala ACL-RSI antes de la cirugía y a los 3, 6 y 9 meses después, además del retorno al deporte al año y a los 2 años.
### Diferencias observadas
Antes de la cirugía, los puntajes no diferían significativamente entre grupos (p = 0,28). Pero durante la rehabilitación, los atletas de élite tuvieron puntajes significativamente más altos a los 3, 6 y 9 meses, y mayores tasas de retorno al deporte al año (86% vs. 69%) y a los 2 años (94,3% vs. 86,7%).
### El hallazgo clave: no es solo «ser élite»
Al ajustar por otros factores en el análisis multivariado, la función de la rodilla (puntaje IKDC) y el sexo masculino fueron los predictores más fuertes de la preparación psicológica —y ser atleta de élite dejó de ser, por sí mismo, un predictor independiente. Por eso los autores concluyen que la intervención psicológica debería considerarse para TODOS los atletas, no solo para los de élite.
🎯 Aplicación clínica para LATAM: Los programas de rehabilitación de LCA en la región no deberían reservar el apoyo psicológico solo para atletas de élite: este estudio sugiere que factores como la función de la rodilla y el sexo importan más que el nivel competitivo, por lo que todos los pacientes se benefician de esa atención.
⚠ Limitaciones: Es un estudio de cohorte con emparejamiento por puntaje de propensión (nivel de evidencia 3), no un ensayo aleatorizado, por lo que no se puede establecer causalidad directa entre las variables.
Background
Psychological readiness encompasses fear of reinjury, confidence in performance, and risk appraisal. It is increasingly recognized as a critical factor influencing return to play (RTP) after anterior cruciate ligament (ACL) reconstruction (ACLR). Elite athletes typically exhibit high self-efficacy and a strong athletic identity while also facing intense external pressure to return. While these dynamics undoubtedly influence their response to injury and psychological recovery after ACLR, the precise differences in psychological readiness between elite and nonelite athletes have not been reported.
Purpose
To compare psychological readiness between elite and nonelite athletes after primary ACLR.
Study design
Cohort study; Level of evidence, 3.
Methods
A total of 756 participants were included in this study. There were 252 elite athletes and 504 propensity score-matched, nonelite athletes (1:2 ratio). Elite athletes were those who played professional sport, represented their country at international competitions, or played intercounty-level Gaelic Games. Psychological readiness was compared between groups preoperatively and at 3, 6, and 9 months postoperatively using the ACL Return to Sport after Injury scale (ACL-RSI). Participants were contacted at 1 year and 2 years postoperatively to record if they had returned to play. Multivariable analysis was used to identify factors (eg, age, sex, elite level) associated with ACL-RSI scores at 9 months.
Results
Preoperative ACL-RSI scores did not differ significantly between elite and nonelite groups (50.6 ± 27.4 vs 48.1 ± 26.6; P = .28). However, elite athletes had higher scores at 3 months (58.6 ± 23.4 vs 53.1 ± 21.9; P < .001), 6 months (67.4 ± 19.9 vs 63.1 ± 19.4; P = .01) and 9 months (72.7 ± 19.9 vs 68.6 ± 19.2; P = .009). Elite athletes had significantly higher RTP rates at 1 year (86% vs 69%; P < .001) and 2 years (94.3% vs 86.7%; P < .002). Multivariate analysis revealed that International Knee Documentation Committee score at 9 months (β = 1.10; 95% CI, 0.95-1.25; P < .001) and male sex (β = 3.7; 95% CI, 0.8-6.6; P < .01) were most associated with increased ACL-RSI scores at 9 months. After adjusting for other factors, elite status was not an independent predictor of psychological readiness.
Conclusion
Our study demonstrated that preoperative ACL-RSI scores were comparable between elite and nonelite athletes. However, elite athletes had consistently higher ACL-RSI scores during rehabilitation and ultimately greater RTP rates. Knee function and male sex are the strongest predictors of ACL-RSI score. Being an elite athlete is not a primary predictor of psychological readiness, and psychological intervention should be considered in all athletes.
Cómo citar:
McAleese T, Kilkenny CJ, Barr J, King E, Moran KA, Jackson M, Withers D, Moran R, Devitt BM. (2026).
Psychological Readiness in Elite Versus Nonelite Athletes After Anterior Cruciate Ligament Reconstruction.. Orthopaedic journal of sports medicine.
DOI: 10.1177/23259671251378746 ↗ PMID: 41836002 ↗ Acceso al paper: Ver completo ↗
