From Fear to Function: How Physiotherapists Navigate Psychological Challenges in Patients Undergoing Rehabilitation After ACL Reconstruction

Background: Psychological readiness plays a critical role in return to sport (RTS) outcomes after anterior cruciate ligament reconstruction (ACLR), yet physiotherapists (PTs) often feel unprepared to support this aspect of recovery. Although clinical guidelines advocate for psychological strategies, practical tools and structured interventions remain scarce. Hypothesis: Experienced PTs will actively use psychological strategies during rehabilitation to support patient readiness for RTS. PTs perceive themselves as playing a central role in addressing psychological barriers. Study Design: Qualitative study using semi-structured focus group interviews. Level of Evidence: Level 5. Methods: A total of 21 experienced PTs were recruited based on their involvement in ACLR rehabilitation. Three focus group interviews were conducted in each country using a semi-structured guide, developed in English and translated into Norwegian/Dutch. Interviews conducted via video call were recorded, transcribed verbatim, and analyzed using systematic text condensation to identify key themes. Results: PTs reported investing considerable time in building therapeutic alliances, enabling them to support psychological readiness throughout ACLR rehabilitation. Common strategies included individualized communication, goal-setting, reassurance through milestone tracking, and graded exposure to sport-specific movements. PTs also adapted their approaches based on patient responses. However, barriers such as time constraints, lack of formal psychological training, and organizational disruptions were identified. Conclusion: PTs play an essential role in addressing psychological readiness in ACLR rehabilitation. Key strategies include building alliances, individualized support, and gradually reintroducing patients to sport-specific activities. Despite their efforts, limited psychological training and structural challenges can hinder optimal care. Addressing these gaps may enhance rehabilitation outcomes and RTS success. Clinical Relevance: This study provides practical insight into how PTs manage psychological challenges in ACLR rehabilitation. Findings highlight the need for more formal psychological training and integrated interdisciplinary approaches to better support recovery and improve RTS outcomes.