This prospective study of 187 athletes asked whether psychological factors predict return to preinjury sport by 12 months after ACL reconstruction. It measured psychological readiness, fear of reinjury, mood, locus of control, and recovery expectations before surgery and at 4 months postoperatively. The primary outcome was actual return to the preinjury level of sports participation at 12 months.
Physical criteria — hop tests, knee laxity, IKDC evaluation. Tell you the graft is intact, not whether the athlete will walk back onto the field. In this cohort, 91% met objective clearance standards, yet 69% never returned to preinjury sport by 12 months.
When your post-ACL reconstruction patient passes physical criteria but seems hesitant at the 4-month visit, administer the ACL-RSI. A score below 56 identifies athletes at meaningful risk of not returning and should prompt targeted psychological support alongside standard rehab.
Before surgery, the athlete's own estimate of how long recovery will take is itself a predictor: patients who anticipated longer recoveries were significantly less likely to return. Asking this question in your preoperative visit costs nothing and stratifies risk.
Competitive athletes returned at higher rates than recreational athletes (P = .02), which likely reflects greater motivation and identity investment in sport. Worth factoring into shared decision-making conversations about realistic expectations after reconstruction.
This prospective study of 187 athletes asked whether psychological factors predict return to preinjury sport by 12 months after ACL reconstruction. It measured psychological readiness, fear of reinjury, mood, locus of control, and recovery expectations before surgery and at 4 months postoperatively. The primary outcome was actual return to the preinjury level of sports participation at 12 months.
Physical criteria — hop tests, knee laxity, IKDC evaluation. Tell you the graft is intact, not whether the athlete will walk back onto the field. In this cohort, 91% met objective clearance standards, yet 69% never returned to preinjury sport by 12 months.
When your post-ACL reconstruction patient passes physical criteria but seems hesitant at the 4-month visit, administer the ACL-RSI. A score below 56 identifies athletes at meaningful risk of not returning and should prompt targeted psychological support alongside standard rehab.
Before surgery, the athlete's own estimate of how long recovery will take is itself a predictor: patients who anticipated longer recoveries were significantly less likely to return. Asking this question in your preoperative visit costs nothing and stratifies risk.
Competitive athletes returned at higher rates than recreational athletes (P = .02), which likely reflects greater motivation and identity investment in sport. Worth factoring into shared decision-making conversations about realistic expectations after reconstruction.