The Importance of Psychological Readiness to Return to Sport After ACL Surgery

Indergaug et al recently published a study titled, "The Role of Psychological Readiness in Return to Sport Assessment After Anterior Cruciate Ligament Reconstruction."

The authors sought to examine the predictive ability of a return to sport (RTS) test battery on return to preinjury level of sport and reinjury when evaluation of psychological readiness was incorporated.

What did the authors find?

129 patients were recruited 9 months after ACLR. Inclusion criteria were age ≥16 years and engagement in sports before injury.
Baseline testing included single-leg hop tests, isokinetic strength tests, the International Knee Documentation Committee (IKDC) Subjective Knee Form 2000, a custom-made RTS questionnaire, and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale.
The RTS criteria were IKDC 2000 score ≥85% and ≥85% leg symmetry index on hop and strength test.

Out of the 103 patients who completed the 2-year follow-up, 42% returned to their preinjury level of sport.

ACL-RSI (which focuses on assessing the psychological readiness to return to sport) at 9 months after surgery and age predicted RTS.

An ACL-RSI score <47 indicated that a patient was at risk of not returning to sport

The functional tests did not predict RTS.

6 patients sustained ACL reinjuries and 7 underwent surgery for other knee complaints/injuries after RTS testing.

None of the 29 patients who passed all RTS criteria, and were therefore cleared for RTS, sustained a second knee injury.

What does this mean?

ACL-RSI and age were predictors of 2-year RTS, while functional tests were not informative. Another main finding was that none of the patients who passed the 85% RTS criteria sustained another knee injury.

This study highlights the importance of assessing and addressing the psychological readiness to return to sport.

Author

Dr. Catherine Logan, MD, MBA Catherine Logan, MD, MBA, MSPT, is a sports medicine orthopaedic surgeon specializing in complex knee and shoulder surgery at Colorado Sports Medicine and Orthopaedics (COSMO) in Denver, Colorado. As a former physical therapist & trainer, Dr. Logan provides a distinct expertise in sports injury, prevention, and surgical management.

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