{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:07:23Z","timestamp":1789729643184,"version":"4.0.1"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"abstract":"\n Purpose<\/jats:title>\n To evaluate how patients rate their knee confidence after anterior cruciate ligament injury, when confidence in their knee returns after anterior cruciate ligament reconstruction (ACLR), and how knee confidence correlates with self\u2010reported outcomes related to return to sport and activity.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective analysis was done on a consecutive cohort of patients who underwent a primary ACLR with hamstring auto\u2010 and allograft between October 2012 and August 2022 with a minimum 2\u2010year follow\u2010up. Patients who had a concomitant ligament surgery, revision ACLR, quadriceps or bone\u2013patellar tendon\u2013bone autograft, concurrent osteotomy, or were missing Knee Injury and Osteoarthritis Outcome Score Question #41(\u201cHow much are you troubled with lack of confidence in your knee?\u201d) at any timepoint were excluded. Patients were considered as lacking knee confidence if they answered \u201cModerately,\u201d \u201cSeverely,\u201d or \u201cExtremely.\u201d The trend of lack of knee confidence from preoperative to 2\u2010year postoperative timepoints was examined, and the associations between the lack of confidence and the Knee Injury and Osteoarthritis Outcome Score Sports\/Rec subscale as well as the Marx Activity Rating Scale were explored.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 165 patients met the inclusion criteria. Preoperatively, 88.5% of patients expressed a lack of confidence in their knees. This percentage declined, reaching 24.2% at 2\u2009years post\u2010ACLR. Age, sex, and graft type were not associated with knee confidence at any timepoint. Additionally, patients who expressed lack of knee confidence at 2\u2009years postoperatively had significantly lower Marx Activity Rating Scale (4.7 vs 8.9,\n P<\/jats:italic>\n \u2009<\u2009.001) and Knee Injury and Osteoarthritis Outcome Score Sport\/Rec scores (58.1 vs 85.7,\n P<\/jats:italic>\n \u2009<\u2009.001) and were less likely to have achieved minimal clinically important difference (70.6% vs 91.2%,\n P<\/jats:italic>\n \u2009=\u2009.002) compared with those with confidence at 2\u2009years postoperatively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study shows improvement in knee confidence post\u2010ACLR with factors such as sex, age, graft type, and size having no notable impact. Lack of knee confidence correlates with lower functional scores at 2\u2009years post\u2010ACLR.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level III, retrospective comparative case series.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/arj.70553","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:47:07Z","timestamp":1789728427000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lack of Knee Confidence Is Associated With Lower Functional Scores After Anterior Cruciate Ligament Reconstruction at 2\u2010Year Follow\u2010Up"],"prefix":"10.1002","author":[{"given":"Abigail R.","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Brigham and Women's Hospital Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jillian L.","family":"Mazzocca","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Brigham and Women's Hospital Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5811-9467","authenticated-orcid":false,"given":"Ming","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery National University Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia L.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Brigham and Women's Hospital Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuchiao","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Medicine Massachusetts General Hospital Boston Massachusetts U.S.A."},{"name":"Harvard Medical School Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2104-4670","authenticated-orcid":false,"given":"Jeffrey N.","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Brigham and Women's Hospital Boston Massachusetts U.S.A."},{"name":"Harvard Medical School Boston Massachusetts U.S.A."},{"name":"Department of Medicine Brigham and Women's Hospital Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8592-7187","authenticated-orcid":false,"given":"Elizabeth G.","family":"Matzkin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Brigham and Women's Hospital Boston Massachusetts U.S.A."},{"name":"Harvard Medical School Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"232596712096942","DOI":"10.1177\/2325967120969425","article-title":"Who passes return\u2010to\u2010sport tests, and which tests are most strongly associated with return to play after anterior cruciate ligament reconstruction?","volume":"8","author":"Webster KE","year":"2020","journal-title":"Orthop J Sports Med."},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1136\/bjsports-2013-093398","article-title":"55 per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: An updated systematic review and meta\u2010analysis including aspects of physical functioning and contextual factors","volume":"48","author":"Ardern CL","year":"2014","journal-title":"Br J Sports 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sports 1 year after ACL reconstruction in competitive athletes","volume":"28","author":"Kitaguchi T","year":"2020","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_21_1","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.ptsp.2021.04.009","article-title":"The psychological readiness to return to sports of patients with anterior cruciate ligament reconstruction preoperatively and 6 months postoperatively","volume":"50","author":"Ohji S","year":"2021","journal-title":"Phys Ther Sport."},{"key":"e_1_2_8_22_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ptsp.2019.10.006","article-title":"Worse knee confidence, fear of movement, psychological readiness to return\u2010to\u2010sport and pain are associated with worse function after ACL reconstruction","volume":"41","author":"Hart HF","year":"2020","journal-title":"Phys Ther 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MA","year":"2015","journal-title":"J Am Acad Orthop Surg."},{"key":"e_1_2_8_26_1","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1177\/0363546518773757","article-title":"Factors associated with psychological readiness to return to sport after anterior cruciate ligament reconstruction surgery","volume":"46","author":"Webster KE","year":"2018","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_27_1","doi-asserted-by":"crossref","first-page":"3112","DOI":"10.1177\/03635465231192983","article-title":"Factors associated with sports function and psychological readiness to return to sports at 12 months after anterior cruciate ligament reconstruction: A cross\u2010sectional study","volume":"51","author":"Cronstr\u00f6m A","year":"2023","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_28_1","doi-asserted-by":"crossref","first-page":"2523","DOI":"10.1177\/0363546512456836","article-title":"Return to high school\u2010 and college\u2010level football after anterior cruciate ligament reconstruction: A multicenter orthopaedic outcomes network (MOON) cohort study","volume":"40","author":"McCullough KA","year":"2012","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_29_1","doi-asserted-by":"crossref","first-page":"3339","DOI":"10.1177\/0363546519878159","article-title":"Return to play and long\u2010term participation in pivoting sports after anterior cruciate ligament reconstruction","volume":"47","author":"Lindanger L","year":"2019","journal-title":"Am J Sports 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