Mental Skills Coaching for ACL Tear

(ROAR 2:Pilot Trial)

Overseen By Shannon McGurty, BS

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: Boston Children's Hospital

Disqualifiers: MCL, LCL, PCL tears

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 10

Duration: 9 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores mental skills coaching for young athletes who have torn their ACL (a key knee ligament) and are undergoing surgery. The goal is to determine if mental training can boost athletes' readiness and confidence to return to sports post-surgery and recovery. English-speaking athletes aged 8 to 25, having their ACL repaired at Boston Children's Hospital and without other major knee ligament tears, can participate. As an unphased trial, it provides a unique opportunity to contribute to research that could improve recovery and confidence for young athletes.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this mental skills coaching is safe for adolescent athletes?

Research has shown that Mental Skills Coaching, a type of psychological support, is generally safe for people recovering from ACL injuries. This coaching helps individuals manage challenges after surgery. No major safety issues have been reported with this method. Instead, it often boosts confidence and motivation. As a non-physical treatment, it doesn't carry the same risks as medication or surgery. Overall, it is well-tolerated and can be a helpful tool during recovery. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about mental skills coaching for ACL tears because it shifts the focus from just physical recovery to also enhancing mental resilience. Unlike traditional treatments that primarily focus on surgery and physical rehab, this approach integrates mental conditioning techniques to help athletes maintain motivation and confidence throughout their recovery journey. This method is designed to equip athletes with mental strategies that not only aid in overcoming the psychological challenges of injury but also enhance overall performance post-recovery.

What evidence suggests that mental skills coaching is effective for ACL tear recovery?

Research has shown that mental skills coaching can aid athletes in recovering from ACL (anterior cruciate ligament) surgery. One study with 69 patients found that a program focused on thinking and behavior improved their mental state before surgery. Feeling mentally ready, such as being confident and less afraid of re-injury, is crucial for a successful return to sports. In this trial, participants will receive mental skills coaching alongside standard-of-care ACL reconstruction and follow-up care. This coaching boosts motivation, consistency, and resilience during recovery, helping athletes feel more prepared to return to action. These mental strategies assist athletes in managing the emotional ups and downs of recovery, facilitating a confident return to their sports. ^{1 2 3 5 6}

Who Is on the Research Team?

Matthew D Milewski, MD

Principal Investigator

Boston Children's Hospital

Are You a Good Fit for This Trial?

This trial is for English-speaking adolescent athletes aged 8 to 25 who are undergoing ACL reconstruction surgery at Boston Children's Hospital due to a complete tear. It's not for those with additional severe ligament tears requiring reconstruction.

Inclusion Criteria

My ACL is completely torn.

English-speaking

I am between 8 and 25 years old at the time of my surgery.

Exclusion Criteria

I need surgery for a torn MCL, LCL, or PCL.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Preoperative Consultation

Participants undergo a preoperative consultation to discuss the mental skills training and standard ACL reconstruction procedure

1 visit

1 visit (in-person)

Treatment

Participants receive mental skills training alongside standard-of-care ACL reconstruction and follow-up care

9 months

6 visits (in-person)

Follow-up

Participants are monitored for psychological readiness to return to sport and stress levels after treatment

6-9 months

3 visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Mental Skills Coaching

Trial Overview The study tests if mental skills coaching can help young athletes feel more ready to return to sports after ACL surgery and recovery. Participants will receive this training along with standard clinical care, assessing its feasibility and impact.

How Is the Trial Designed?

Group I: Intervention Experimental Treatment 1 Intervention

Participants will receive mental skills training in addition to receiving standard-of-care ACL reconstruction and follow-up care. The goal of mental skills training is to help athletes maximize performance, reach self-determined goals, and build confidence in their fields of play. Many of the same tools that benefit athletes in sport performance also translate to their injury experience. Mental conditioning helps athletes navigate the many ups and downs that accompany ACL injury and recovery. Athletes are taught techniques to maintain their sport mindset by capitalizing on motivation, consistency, and resilience. One-on-one sessions are athlete-centered, and are designed to encourage exploration and growth through tangible mental skills strategies.

Who Is Running the Clinical Trial?

Boston Children's Hospital

Lead Sponsor

Trials

801

Recruited

5,584,000+

Published Research Related to This Trial

A study involving 11 UK student physiotherapists revealed that while they understand the importance of goal setting in ACL rehabilitation, they feel unprepared and have received minimal training on the subject.

Participants expressed a desire for more training in goal setting practices, highlighting a need for improved education in psychological strategies within physiotherapy programs to enhance patient involvement in rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An exploration of UK student physiotherapists' goal setting practices within anterior cruciate ligament rehabilitation. Alexanders, J., Chesterton, P., Brooks, A., et al.[2022]

A study involving 69 patients undergoing ACL surgery showed that an interactive cognitive-behavioral multimedia program significantly improved preoperative confidence and reduced postoperative pain and fear of movement compared to standard care.

The multimedia program also enhanced the use and perceived usefulness of educational materials, indicating it could be an effective and cost-efficient way to support patients during ACL surgery and rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Interactive Cognitive-Behavioural Multimedia Program Favourably Affects Pain and Kinesiophobia During Rehabilitation After Anterior Cruciate Ligament Surgery: An Effectiveness Trial. Brewer, BW., Van Raalte, JL., Cornelius, AE.[2023]

Sports physical therapists (PTs) recognize that psychological impairments following an ACL injury can be more significant than physical ones, highlighting the need for better training and resources to address these issues during rehabilitation.

PTs expressed a desire for specific knowledge and interventions focused on psychological aspects of recovery, suggesting that developing psychologically centered rehabilitation programs could enhance patient outcomes after ACL injuries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychological impairments after ACL injury - Do we know what we are addressing? Experiences from sports physical therapists. Piussi, R., Krupic, F., Senorski, C., et al.[2021]

In the ACL-SPORTS trial, 95% of male athletes returned to sport one year after ACL reconstruction, with 78% returning to their preinjury level, and by two years, all athletes had returned to sport, with 95% at their preinjury level.

The incidence of second ACL injuries was very low, with only one athlete experiencing a second injury, indicating that the training program may effectively reduce the risk of re-injury compared to previous literature.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

TWO YEAR ACL REINJURY RATE OF 2.5%: OUTCOMES REPORT OF THE MEN IN A SECONDARY ACL INJURY PREVENTION PROGRAM (ACL-SPORTS). Arundale, AJH., Capin, JJ., Zarzycki, R., et al.[2022]

Citations

1. withpower.com withpower.com/trial/phase-anterior-cruciate-ligament-injuries-3-2022-9c6c1

Mental Skills Coaching for ACL Tear · Info for Participants A study involving 69 patients undergoing ACL surgery showed that an interactive cognitive-behavioral multimedia program significantly improved preoperative ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11569572/

Impact of Psychological Factors on Rehabilitation After ... Five studies described the psychological outcomes of ACL injury and ACLR, primarily fear of reinjury and loss of identity. Neural processing and ...

3. clinicaltrials.gov clinicaltrials.gov/study/NCT05338385?tab=table

Readiness Outcomes Affecting Return to Sport 2.0: An ... Trial Description. This study aims to determine the feasibility of implementing a mental skills training intervention for adolescent athletes who tear their ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11299325/

ACL Injury Prevention Education Improves Implementation ... These survey results show that completion of a training course significantly improved ACL injury prevention knowledge among a cohort of high ...

5. sciencedirect.com sciencedirect.com/science/article/pii/S1440244025000635

Rehabilitation volume, psychological readiness, and motor ... Amongst the variables assessed, exercise volume, psychological readiness, and functional hop/jump abilities are the most important factors for a successful ...

6. sciencedirect.com sciencedirect.com/science/article/pii/S1360859224000378

A brief narrative review of main risk factors for injury and re- ... The re-injury risk (RIR) of ACL is caused by a wide range of factors including age, sex, type of training, premature return to sport, and biomechanical deficit.