AccScience Publishing / HPR / Online First / DOI: 10.36922/hpr.0340
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RESEARCH ARTICLE

Psychological Responses during Anterior Cruciate Ligament Rehabilitation: Associations with Psychological Readiness for Return to Sport

Luis Miguel Ramos-Pastrana1 ,  Laura Gil-Caselles2,3* ,  Roberto Ruíz-Barquín4 ,  Jose Maria Gimenez-Egido2,3 ,  Aurelio Olmedilla-Zafra2,5
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1 Department of Psychology, Psychology, University of Murcia, Murcia 30003, Spain
2 HUMSE Research Group, Department Physical Activity and Sport, Faculty of Sport Sciences, University of Murcia, Campus de San Javier, San Javier 30720, Murcia, Spain
3 Department of Physical Activity and Sport, Faculty of Sport Sciences, University of Murcia, Campus de San Javier, San Javier 30720, Murcia, Spain
4 Interfaculty Department of Developmental and Educational Psychology, Faculty Psychology, Autonomous University of Madrid, Madrid 28049, Spain
5 HUMSE Research Group, Department of Personality, Evaluation, and Psychological Treatment, Faculty of Psychology, University of Murcia, Murcia 30003, Spain
HPR, 0340 https://doi.org/10.36922/hpr.0340
Received: 19 October 2025 | Revised: 20 March 2026 | Accepted: 23 March 2026 | Published online: 5 May 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Background

Anterior cruciate ligament (ACL) injury involves physical and psychological challenges that may influence the rehabilitation process and athletes’ perceptions of readiness to return to sport.

Objective

To explore the associations between mental health variables and psychological responses during ACL rehabilitation, and their relationship with psychological readiness for return to sport, including potential sex differences.

Methods

Eight federation-registered athletes with a previous ACL injury (three men and five women) participated in this exploratory retrospective case series. In a single assessment session, participants retrospectively reported psychological responses across six rehabilitation stages. Measures included trait anxiety, pain catastrophizing, mood states, psychological readiness for return to sport, and symptoms of depression, anxiety, and stress.

Results

Higher levels of trait anxiety and catastrophizing were associated with more negative mood states (e.g., trait anxiety correlated with depression, ρ = 0.755, p < 0.05) and lower psychological readiness for return to sport (anxiety and readiness: ρ = −0.761, p < 0.05). Descriptive differences were observed between men and women; however, findings should be interpreted cautiously, given the small sample size and retrospective design.

Conclusion

Psychological variables may represent relevant considerations during ACL rehabilitation. The exploratory nature of the study and its retrospective design warrant cautious interpretation and highlight the need for prospective research with larger samples.

Keywords
Anterior cruciate ligament
Return to sport
Mental health
Rehabilitation
Funding
This study was partially supported by the “Mental Health Promotion” project under the agreement between the Football Federation of the Region of Murcia and the University of Murcia (FFRM-UMU-36731-GINVEST-12574).
Conflict of interest
The authors declare no conflicts of interest.
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Health Psychology Research, Print ISSN: 2420-8124, Published by AccScience Publishing
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