How Does Grit Impact ACL Reconstruction Recovery Success?

Does a patient’s grit have an impact on the postoperative experience after ACL reconstruction?

Whether they’re stepping out under the Friday night lights — down by a landslide in the last quarter of the game — or approaching the microphone during the spelling bee’s last round, all kids experience nerves and pressure during childhood. In the face of that resistance, there are two options: push forward with a focused mind or crack under the pressure. The resilience to persevere and achieve an end goal despite adversity is the intangible quality inside us that leads to success: grit. Children’s Hospital Colorado sports medicine physician Aubrey Armento, MD, wondered how a patient’s grit level might impact the postoperative experience after anterior cruciate ligament (ACL) surgery. She teamed up with Jay Albright, MD, Curtis VandenBerg, MD, and David Howell, PhD, to search for answers.

Exploring the short grit scale

The first hurdle was to bottle up this difficult-to-measure quality and clearly define grit: What is it and how can you measure it in a patient? For this study, Dr. Armento and her team classified grit as the “passion and perseverance to purse long-term goals despite challenges or setbacks,” and they used a validated measure of grit called the short grit scale created by psychologist Angela Duckworth, PhD (1). This questionnaire asks patients to read a series of statements and rate how much each statement applies to them.

Along with the short grit scale, Dr. Armento also evaluated patients in two other categories: knee symptomatology (such as pain, swelling and range of motion) and physical function and activity-level outcomes. The team gathered these responses prior to surgery, then three times after surgery at three, six and 12 months postoperatively. The participants included 137 patients whose average age was almost 16 years old.

Grit and ACL reconstruction recovery findings

The study found those with higher preoperative grit achieved greater physical function and activity levels over time than those with lower grit. “I think athletes who tend to have higher grit are more dedicated to the rehab and recovery process and continue to show up even when it’s more challenging,” Dr. Armento says.

The team did not find a connection between grit and knee symptomatology, which Dr. Armento says is because improvement of knee symptoms may not be perceived as a more tangible goal when compared to attainment of physical function and activity levels.

“I think one of the takeaways from this is that assessment of grit, especially in that preoperative stage, may be a useful predictor of success in recovery over time,” Dr. Armento says. “I think it’s probably most applicable to physical therapists who are working week in, week out with these patients over a year’s time and identification of those who may have lower grit. [Those patients] may need an alternative approach to keep [them] more engaged and dedicated to their physical therapy and their rehab process.”

The team also found that grit levels typically remained consistent before and after surgery.

“It is proposed that grit can be grown over time,” Dr. Armento explains. “We think it’s a little bit more of an innate personality trait but can be influenced by environment.”

She hopes to explore ways to increase grit in athletes along with studying how this might relate to an athlete’s success in returning to their sport after surgery and physical therapy.

1. Armento, Aubrey et al. “Association of Grit With Postoperative Knee Outcomes and Physical Function After ACL Reconstruction in Adolescent Athletes.” The American journal of sports medicine vol. 51,11 (2023): 2900-2907. doi:10.1177/03635465231187040.