Patients' Mental Barriers in Rehabilitation after ACL Reconstruction: A Qualitative Interview Study.

Background: Recovery after anterior cruciate ligament reconstruction (ACLR) involves both physical and psychological challenges. Although psychological readiness for return to sport (RTS) is increasingly recognized as important, less is known about how patients experience psychological barriers during rehabilitation and how interactions with physiotherapists (PTs) may shape this process.

Purpose: To explore how patients recovering from ACLR navigate potential psychological barriers, what helps them overcome these barriers, and how they experience the role of PTs in enhancing their psychological readiness.

Study design: Qualitative interview.

Methods: Nine patients (5 women, 4 men), aged 19-45 years, from Norway and the Netherlands, 5-9 months post-ACLR, were recruited for individual semi-structured interviews. Data were analyzed using systematic text condensation.

Results: Three themes emerged: (1) The Mental Landscape of Rehabilitation - confidence builds through physical progress amidst emotional setbacks; (2) Pillars of Support - professional and social support, especially from PTs, helps manage fear and build trust; (3) Lessons Learned Along the Way - patients develop insight, resilience, and personalized strategies for mental recovery. Psychological readiness was experienced as a dynamic process shaped by physical progress, emotional responses, support systems, and interactions with PTs.

Conclusion: Psychological readiness should be viewed as an evolving component of ACLR recovery, shaped by patients' experiences, support systems, and interactions with PTs. These

Findings: highlight the importance of a holistic and individualized rehabilitation approach that acknowledges mental barriers, supports confidence-building, and considers referral to mental health professionals when needed. Level of evidence 5 (Qualitative Study).