Summary

There’s a correlation between psychological factors measured through the ACL-RSI score at 6 months after ACL reconstruction and activity level at mid-term follow-up underlining the relationship between RTS and psychological effects, and the importance of ACLR rehabilitation to focus on decreasing apprehension and fear.

Abstract

Introduction

Evaluation allowing to return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) should be multimodal, including a psychological evaluation. The goal of the study was to determine if there is a correlation between ACL–Return to Sport after Injury (ACL-RSI) score at 6-months post-ACLR and mid-term functional results.

Methods

A total of 498 patients were assessed 6 months after primary ACLR using a composite test including isokinetics, hops, and ACL-RSI. A minimum of 3 years follow-up was necessary. At the last follow-up, each patient completed clinical and functional evaluations including subjective International Knee Documentation Committee (IKDC) score, Tegner Activity Scale, Self Knee Value (SKV), and ACL-RSI scores. Results were compared overall and item by item.

Results

At the last follow-up, mean SKV, Tegner, IKDC, and ACL-RSI scores were 86.8 ± 14.3%, 6 ± 2.1, 77 ± 11.9%, and 68.8 ± 25.7%, respectively. A significant correlation existed between 6-month ACL-RSI score and each functional test (respectively ρ=0.189 p<0.001; ρ=0.174 p<0.001; ρ=0.237 p<0.001). ACL-RSI score was significantly higher than at 6 months after surgery (p<0.001). Over half (59.2%) of the cohort returned to an equal or greater level of activity and there was a significant correlation between 6-month ACL-RSI score and post-surgery level of activity.

Conclusions

Patients with better ACL-RSI score at 6 months post-ACLR, have better functional results medium-term and are more likely to RTS. Our results show a correlation between psychological factors at 6 months, measured through the ACL-RSI score, and activity level at mid-term follow-up. The study underlines the relationship between RTS and psychological effects, and the importance of ACLR rehabilitation to focus on decreasing apprehension and fear.