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Chapter 9186to return to sports are important factors in return to sports.3 These factors are potentially modifiable,4,42 and some patients may benefit from cognitive behavioural therapy over the course of their rehabilitation process. Using questionnaires like the ACL-Return to Sports after Injury, Tampa Scale for Kinesiophobia and Knee Self Efficacy Score, patients in need of cognitive behavioural therapy can be identified.It is important that practitioners pay attention to the psychosocial aspects of an ACL injury. This type of psychological counselling is still not reimbursed by basic insurance in the Netherlands. Treatment of psychological problems – in the absence of a psychological disorder according to the DSM-5 – is not covered by medical insurance. And although orthopaedic surgeons may not have – or allow themselves – the time to provide concrete psychological treatment for patients in need, they should not neglect their role in enhancing the psychological wellbeing of their patients.29 It does not take long to let a patient know that psychological struggles frequently occur during rehabilitation after ACL injury, and acknowledgement of these feelings is reported to be important for patients.29 ‘Simple’ cognitive behavioural interventions can be initiated by the treating physical therapist, such as realistic goal-setting, small success experiences, group rehabilitation, time projection, self-desensitisation and disputing catastrophic thoughts.21 Also, it has been suggested by Burland et al. that cognitive behavioural therapies could be used to improve fearrelated emotions, motivation and self-efficacy. This can be achieved by using imagery, mindfulness, guided relaxation and breathing techniques.4But practitioners must be aware that postinjury depression is reported in 5-21% of patients and appropriate referral in such cases is imperative.21At this stage, the added value of psychological interventions seems apparent yet needs further research. This thesis contributes to the growing evidence that psychological factors play an important role after ACL injury, not only in return to sports but also in return to previous levels of daily activities and work-related activities.Mark Zee.indd 186 03-01-2024 08:56