Background: High psychological readiness is an important element for returning to sports after anterior cruciate ligament (ACL) reconstruction. Identifying factors that contribute to psychological readiness is essential for planning interventions to return to play. No studies have used multivariate analysis to clarify factors associated with psychological readiness to return to specific sports. Hypothesis: To identify factors that contribute to an athlete’s psychological readiness to return after ACL reconstruction to sports that require cutting, pivoting, and jump-landings. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Study participants were athletes who before injury had participated in sports with limited contact that required cutting, pivoting, and jump-landings (basketball, soccer, futsal, volleyball, badminton, tennis, and frisbee) and hoped to return to the same sport after reconstruction. Psychological readiness was measured using the Anterior Cruciate Ligament–Return to Sport After Injury Scale (ACL-RSI) in athletes more than 6 months after primary ACL reconstruction. To clarify factors associated with the ACL-RSI, univariate regression analysis and multivariate regression analysis were performed using the following independent variables: age, sex, body mass index, time from injury to reconstruction, time from reconstruction to testing, meniscal surgery, modified Tegner activity scale before injury, kinesiophobia, limb symmetry index of knee strength, limb symmetry indices of single-leg hop (SLH) distances, and subjective running ability. Results: Higher subjective running ability, a lower kinesiophobia score, and greater limb symmetry in the lateral SLH were positively associated with psychological readiness. Conclusion: The psychological readiness of athletes aiming to return after ACL reconstruction to limited-contact sports that require cutting, pivoting, and jump-landings was affected by subjective running ability, kinesiophobia, and asymmetry of lateral SLH distance. This information may be useful in planning appropriate interventions and thereby increasing the likelihood of an athlete’s returning to such sports.

Purpose The anterior cruciate ligament‐return to sports after injury (ACL‐RSI) scale assesses the psychological impact of returning to sports (also referred to as psychological readiness) after ACL reconstruction. The aim of this study was to evaluate important measurement properties of the Japanese version of ACL‐RSI scale. Methods Ninety‐three participants who underwent ACL reconstruction filled out the Japanese version of ACL‐RSI scale, the Tampa scale for kinesiophobia (TSK), the International Knee Documentation Committee‐Subjective Knee Form (IKDC‐SKF), and Knee injury and Osteoarthritis Outcome Score (KOOS). To assess test re‐test reliability, 50 of the 93 participants re‐answered the Japanese version of ACL‐RSI scale within 10 days. Floor and ceiling effects, internal consistency, construct validity, and reliability of the Japanese version of ACL‐RSI scale were analysed. Results There were no floor and ceiling effects. The Japanese version of ACL‐RSI scale showed good internal consistency (Cronbach's alpha = 0.912). It was positively correlated with total points of IKDC‐SKF and the Lysholm score, and with the all sub‐categories of the KOOS, and it was negatively correlated with the TSK. Reliability of the Japanese version of ACL‐RSI scale was satisfactory. Conclusion The Japanese version of ACL‐RSI scale has acceptable measurement properties. It can be a useful for evaluation of psychological readiness for return to sports in Japanese athletes who undergo primary ACL reconstruction. Information provided by the Japanese version of the ACL‐RSI scale may also help to identify athletes who find return to sport a challenge, and guide conversations regarding treatment and rehabilitation plans. Level of evidence II.

Background: On a questionnaire administered to athletes who had undergone anterior cruciate ligament reconstruction (ACLR), some answered “yes” to a question regarding return to sports (RTS) at the preinjury level despite having lower postoperative subjective athletic performance (PoSAP) intensity compared with preoperative levels. Purpose: To investigate the agreement between responses regarding RTS and PoSAP intensity after ACLR. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 44 individuals, 24.8 ± 18.4 months after ACLR, participated in this study. They completed a questionnaire in which PoSAP was graded as a percentage of preoperative performance level. They also gave dichotomous responses (yes/no) to the question of whether they had been able to RTS at the same level as before their injury (RTS question). Participants were divided into 2 groups according to their PoSAP scores using different cutoff values (100%, 90%, 80%, and 70%), and an exploratory analysis was conducted of the cutoff value for dividing PoSAP scores that provided the greatest agreement with the response to the RTS question. Results: The mean PoSAP score was 87.5% ± 14.9%, and 33 participants (75%) answered “yes” to the RTS question. The agreement between the PoSAP score and the RTS question was lowest when the cutoff value was 100% (κ = 0.294) and highest when the cutoff value was 80% (κ = 0.676) and 90% (κ = 0.632). Conclusion: More athletes who had undergone ACLR answered “yes” to the RTS question even when their PoSAP score was around 80%. Asking only for dichotomous responses may result in overestimating the level to which these athletes’ performance has recovered after ACLR.

Background This study aimed to determine the relationships between athletic identity and sport commitment and return to sports (RTS) status in athletes after anterior cruciate ligament reconstruction (ACLR). Methods Thirty-nine participants post-ACLR (8–24 months) were included in this cross-sectional study. Measures included the athletic identity measurement scale and sport commitment scale. In addition, we measured kinesiophobia and psychological readiness using the Tampa Scale for Kinesiophobia and ACL-Return to sport after injury scale. The subjects were categorized into Yes-RTS or No-RTS based on two questions to determine whether they were returning to sport at the same level of competition as before the injury. A Chi-squared test, Fisher’s exact test, unpaired t-test, and Mann-Whitney’s U test were used to analyze the data. Results The Yes-RTS group had significantly higher scores on the athletic identity measurement scale (P = 0.023, effect size [ES] = − 0.36), sport commitment scale (P = 0.027, ES = − 0.35), and ACL-Return to sport after injury scale (P = 0.002, ES = − 0.50) and significantly lower Tampa Scale for Kinesiophobia scores (P = 0.014, ES = − 0.39) compared to the No-RTS group. Conclusion Athletes who returned to sports at the same level of competition as before the injury had higher athletic identity and sport commitment and lower kinesiophobia compared to those who did not return to sports at the same level of competition. These self-beliefs regarding sport may play an important role in post-ACLR athletes’ RTS.

[Purpose] The purpose of this study was to examine limb-dominance and gender differences in the magnitude of the ground reaction force during single-leg lateral jump-landings. We hypothesized that the peak ground reaction force would be larger in the non-dominant leg compared to that in the dominant leg and would be larger in females compared to that in men. [Subjects and Methods] Fifteen females and 15 males performed jump-landings sideways from a height of 20 cm, with a lateral distance of 60 cm. Vertical and medial ground reaction forces were measured, and the elapsed time from the initial contact to the peak ground reaction force was determined. The loading rate was calculated as the peak ground reaction force divided by the elapsed time from the initial contact to the peak ground reaction force. [Results] The vertical and medial peak ground reaction forces during single-leg lateral jump-landings were larger in females compared to that in males. In addition, the medial peak ground reaction force was larger for the non-dominant leg compared to that for the dominant leg. [Conclusion] The results suggest that in rehabilitation and conditioning settings, evaluations and instructions regarding attenuation are especially important for females and the non-dominant leg.