Progression of the Psychological ACL-RSI Score and Return to Sport After Anterior Cruciate Ligament Reconstruction: A Prospective 2-Year Follow-up Study From the French Prospective Anterior Cruciate Ligament Reconstruction Cohort Study (FAST)

Abstract

Background:Successful return to sport after anterior cruciate ligament (ACL) reconstruction requires optimal physical and psychological recovery. The main validated tool to quantify a patient’s psychological readiness to return to sport after this surgery is the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scale.Purpose:The primary aim was to analyze the progression of the ACL-RSI score from preoperatively to 2-year follow-up. A secondary goal was to identify the factors associated with returning to the same preinjury sport.Study Design:Cohort study; Level of evidence, 2.Methods:This prospective study included athletes older than 16 years in all sports and levels of play who underwent primary and revision isolated ACL reconstruction from 2012 to 2015 and responded to all study questionnaires at 2-year follow-up. The primary outcome was the ACL-RSI score obtained preoperatively and at 4-month, 6-month, 1-year, and 2-year follow-up. The secondary outcomes were return to sport (running and the same preinjury sport) and various functional scores. The optimal threshold value of the ACL-RSI score for returning to the same preinjury sport was determined with the receiver operating characteristic curve. Multivariate analysis was performed to identify other factors associated with returning to the same sport at 2-year follow-up.Results:A total of 681 patients were analyzed (467 men, 214 women; mean age, 30.2 ± 9.5 years); 298 (43.8%) patients were professional or competitive athletes. The ACL-RSI score improved significantly over time: 41.3 ± 25.4 preoperatively, 55.1 ± 21.3 at 4 months, 58.3 ± 22.3 at 6 months, 64.7 ± 24.2 at 1 year, and 65.2 ± 25.3 at 2 years (P < .00001). At 2-year follow-up, 74.9% of patients had returned to running and 58.4% to their same preinjury sport. The ACL-RSI score was significantly higher in patients who had returned to sport and in those who returned to the same level of play or higher (P < .00001). The optimal ACL-RSI score threshold to return to the same sport at 2-year follow-up was ≥65. Multivariate analysis showed that the predictive factors of returning to the same preinjury sport at 2-year follow-up were primary reconstruction, professional or competitive level of play, an ACL-RSI score ≥60 at 6-month follow-up, and the absence of postoperative complications.Conclusion:The psychological ACL-RSI score improved regularly after ACL reconstruction and was strongly and significantly associated with return to sport.Registration:NCT02511158 (ClinicalTrials.gov identifier)

Factors Associated With a Return to Preinjury Level of Sport Performance After Anterior Cruciate Ligament Reconstruction Surgery

“…Although there are no other studies with which to directly compare this result, it extends previous studies showing that psychological readiness is associated with return to sport. 3,16,27 More recent work also indicated that psychological readiness is associated with a second ACL injury. 20 Therefore, when combined, previous studies and this body of work emphasize the pervasive role that psychological factors play throughout the recovery period and once the athlete has returned to sport.…”

Return to Sport After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Return to Sport Consensus Group

“…8 This scale was validated by a large cohort study of 681 patients, which reported that an ACL-RSI threshold score at 6 months postoperatively was independently associated with return to preinjury sport at 2-year follow-up. 61 In 2019, a cohort study of 329 patients who returned to sport reported that patients 20 years of age or younger with a second ACL injury had lower psychological readiness scores on the ACL-RSI scale than those without second injury. 47 Early confidence may, however, be deleterious, as higher knee confidence at a younger age has been associated with a higher reinjury rate.…”

Responsiveness of the anterior cruciate ligament – Return to Sports after Injury (ACL-RSI) and Injury – Psychological Readiness to Return to Sport (I-PRRS) scales

“…Hence, the two scales can be used in cross-sectional studies to determine the effect of interventions at the group level. In recent years the ACL-RSI questionnaire has increasingly been used for this purpose (Ardern, Osterberg, et al, 2014;Langford, Webster, & Feller, 2009;Muller, Kruger-Franke, Schmidt, & Rosemeyer, 2015;Sadeqi et al, 2018;Webster et al, 2008).…”