Short-term fear of movement improves less after anterior cruciate ligament reconstruction with concomitant meniscus repair

BACKGROUND

Psychological response is important in return-to-sport decisions for athletes recovering from anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to compare psychological response after ACLR with a concomitant meniscus repair compared to isolated ACLR.

METHODS

Thirty-five individuals completed the Tampa Scale of Kinesiophobia (TSK) and Anterior Cruciate Ligament Return-to-Sport after Injury (ACL-RSI) scale before ACLR and 2, 4, and 6 months after ACLR. Participants were dichotomized based on presence of concomitant meniscus repair (Yes/No). Separate group X time repeated measures analyses of variance were conducted for both scales.

RESULTS

Participants were 65.7% female, 19.1 ± 4.7 years old with BMI of 24.9 ± 4.4 kg/m2. Sixteen individuals had an isolated ACLR with 19 individuals having an ACLR with concomitant meniscus repair. For the TSK, there was a group × time interaction effect(p = 0.028), with improvement in TSK scores for the isolated ACLR group (ACLR:2 months = 24.8 ± 3.7; 4 months = 22.0 ± 5.7; 6 months: 19.9 ± 5.9; Meniscus Repair:2 months = 25.5 ± 4.7; 4 months = 24.1 ± 5.0; 6 months: 23.8 ± 4.7). Six months after ACLR, TSK scores were worse in the meniscus repair group(p = 0.036). For the ACL-RSI, there was no interaction(p = 0.07).

CONCLUSION

Concomitant meniscus repair with ACLR results in less post-operative improvement in kinesiophobia through 6 months after ACLR compared to isolated ACLR.

THE EFFECT OF TIME AND SEX ON POST-ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION PSYCHOLOGICAL PATIENT REPORTED OUTCOME MEASURE SCORES

CONTEXT

Low scores on psychological patient reported outcomes measures (PROMs), including the anterior cruciate ligament-return to sport after injury (ACL-RSI) and injury-psychological readiness to return to sport (I-PRRS), after anterior cruciate ligament (ACL) reconstruction (ACLR) have been associated with a maladaptive psychological response to injury and poor prognosis.

OBJECTIVE

The purpose of this study was to assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores and generate normative reference curves. It was hypothesized that males would demonstrate higher ACL-RSI and I-PRRS scores than females in the first 1-year post-ACLR.

DESIGN

Case series.

SETTING

Outpatient sports medicine and orthopedic clinic.

PATIENTS

507 patients post-primary ACLR 12-to-30-years-old with 796 ACL-RSI or I-PRRS scores one or more times between 0- and 1-year post-ACLR (age at ACLR: 17.9 ± 3.0 y).

MAIN OUTCOME MEASURES

An honest broker provided anonymous data from our institution's knee injury clinical database. Generalized additive models for location, scale, and shape and generalized least squares analyses were used to assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores.

RESULTS

ACL-RSI and I-PRRS scores increased over time post-ACLR, and males had higher scores compared to females up until approximately five months post-ACLR with scores converging thereafter.

CONCLUSIONS

Males report higher ACL-RSI and I-PRRS scores compared to females in the initial stages of rehabilitation, but scores converge between sexes at times associated with return to play following ACLR. Normative reference curves can be used to objectively appraise patients' ACL-RSI and I-PRRS scores at any time point post-ACLR. This may lead to timely identification of patients with scores or changes in scores over time post-ACLR associated with a maladaptive psychological response to injury and a poor prognosis and optimized ACLR outcomes.

The effect of anterior cruciate ligament reconstruction and RAMP lesion repair on psychological status

BACKGROUND

There are few studies examining anterior cruciate ligament reconstruction (ACLR) and RAMP lesion repair. However, no studies have investigated the level of functional performance and psychological state after ACLR and all-inside RAMP lesion repair.

HYPOTHESIS/PURPOSE

The aim of this study is to determine the effect of ACLR and RAMP lesion repair on psychological status. ACLR and meniscal RAMP lesion repair were hypothesized to be associated with better psychological outcomes.

STUDY DESIGN

This is a cohort study.

METHODS

Patients who underwent ACLR with semitendinosus and gracilis autografts by a single surgeon were determined retrospectively. Fifteen patients who underwent ACLR and all-inside meniscus RAMP lesion repair (ACLR-RR) and 15 patients who underwent isolated ACLR were compared. Patients were evaluated by a physiotherapist at least 9 months after surgery. The primary outcome measure was anterior cruciate ligament-return to sports after injury (ACL-RSI), and the psychological status of the patients was examined. Secondary outcomes were visual analog scale (VAS), Tegner activity score, Lysholm knee score, single hop tests, and limb symmetry index (LSI). While pain intensity at rest and during movement was evaluated with VAS, functional performance level was evaluated with the Tegner activity score, the Lysholm knee score, single hop tests, and limb symmetry index (LSI).

RESULTS

A significant difference was found in the ACL-RSI values in the ACLR-RR group compared to the isolated ACLR group (p = 0.02). The results of the groups in VAS scores at rest and during movement, Tegner activity levels, and Lysholm knee scores, in the intact and operated leg single hop tests (single leg hop, cross hop, triple hop, and six-meter hop test), and the LSI values in the single leg hop tests showed no significant difference.

CONCLUSIONS

This study revealed different psychological outcomes and similar functional levels for ACLR and all-inside meniscus RAMP repair compared with isolated ACLR. It was observed that the psychological status of patients with RAMP lesions should also be evaluated.

Hop to It! The Relationship Between Hop Tests and The Anterior Cruciate Ligament - Return to Sport Index After Anterior Cruciate Ligament Reconstruction in NCAA Division 1 Collegiate Athletes

Background

Outcomes after anterior cruciate ligament reconstruction (ACLR) may not be optimal, with poor physical and psychological function potentially affecting return to sport (RTS) ability. Understanding the relationship between commonly used hop tests and the Anterior Cruciate Ligament - Return to Sport Index (ACL-RSI) may improve rehabilitation strategies and optimize patient outcomes.

Hypothesis/Purpose

The purpose of this study was to examine the relationship between ACL-RSI scores and limb symmetry index (LSI) for the single hop for distance (SHD), triple hop for distance (THD), crossover hop for distance (CHD), timed 6-meter hop (T6H), and single leg vertical hop (SLVH) in a cohort of National Collegiate Athletic Association (NCAA) Division 1 collegiate athletes after ACLR. The hypothesis was that SLVH LSI would be more highly correlated with ACL-RSI score than all horizontal hop tests.

Study design

Cross-Sectional Study.

Methods

Twenty-one National Collegiate Athletic Association (NCAA) Division 1 collegiate athletes (7 males, 14 females) at 6.62 ± 1.69 months after ACLR were included in this retrospective study. Primary outcomes were ACL-RSI score and LSI for SHD, THD, CHD, T6H, and SLVH. The relationship between ACL-RSI scores and performance on hop tests (LSIs) was evaluated using correlation analysis and step-wise linear regression (p ≤ 0.05).

Results

There were significant correlations found when comparing ACL-RSI and the LSI for SHD (rs = 0.704, p < 0.001), THD (rs = 0.617, p = 0.003), CHD (rs = 0.580, p = 0.006), and SLVH (rs = 0.582, p = 0.006). The CHD explained 66% (R2 value of 0.660) of the variance in the ACL-RSI, while the other hop tests did not add to the predictive model.

Conclusions

Physical function has the capacity to influence psychological status after ACLR. Clinicians should recognize that SLVH, SHD, THD, and CHD are correlated with ACL-RSI and improvements in physical function during rehabilitation may improve psychological status and optimize RTS after ACLR.

Level of evidence

Level 3.

Validation of the ACL-RSI Scale in Pediatric and Adolescent Patients

BACKGROUND

The Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale is a 12-item questionnaire assessing psychological readiness to return to sport after anterior cruciate ligament reconstruction. It has been validated for use in adults in multiple languages and in an abbreviated 6-question short form. Additionally, literature has been published using this scale in pediatric and adolescent populations, however it has not yet been validated for use with them.

PURPOSE

To validate the ACL-RSI scale for use with pediatric and adolescent patients.

STUDY DESIGN

Cohort study (Diagnosis); Level of evidence, 2.

METHODS

Scores of 6- and 12-item ACL-RSI scales for patients undergoing return-to-sport readiness testing 6 to 8 months after anterior cruciate ligament reconstruction were analyzed. Convergent validity testing was performed against the International Knee Documentation Committee (IKDC)/Pediatric IKDC score, Single Assessment Numeric Evaluation (SANE) score, and peak torque asymmetry of knee flexion and extension using Spearman correlations. Discriminant validity testing was performed against age (Spearman correlation), body mass index (Spearman correlation), and sex (Mann-Whitney U test). Reliability testing was performed by calculating Cronbach's alpha. Floor and ceiling effects were assessed by calculating the number of minimum and maximum scores in the cohort.

RESULTS

A total of 51 patients were included in the final analysis. The mean age at surgery was 15.2 ± 2.2 years, and 51.0% were female. The 6- and 12-item ACL-RSI scales demonstrated a strong significant positive correlation with IKDC/Pediatric IKDC scores (R = 0.723 and 0.717, respectively; P < .001) and moderate significant positive correlation with Single Assessment Numeric Evaluation scores (R = 0.516 and 0.502, respectively; P < .001) Age at surgery, body mass index, and sex were not correlated with either ACL-RSI scale. Cronbach's alpha values of the 12- and 6-item ACL-RSI scales in this population were 0.959 and 0.897, respectively. For both the 12- and the 6-item ACL-RSI scales, no floor or ceiling effects were found as the minimum score (0) was not observed in either version, and the maximum score (100) was only observed twice (3.9%) in both versions.

CONCLUSION

The ACL-RSI scale is valid to use with pediatric and adolescent patients. The 6-item scale may be a better choice because it has fewer redundancies and minimizes the risk of questionnaire fatigue.

Association of Psychological Readiness to Return to Sports With Subjective Level of Return at 12 Months After ACL Reconstruction

Background

Return-to-sports (RTS) rates after anterior cruciate ligament (ACL) reconstruction (ACLR) differ according to the level at which patients return. It is unclear whether the level of RTS is affected by psychological readiness to return.

Purpose

To examine the association between psychological readiness to RTS and subjective RTS level 12 months after ACLR.

Study Design

Case-control study; Level of evidence, 3.

Methods

A total of 47 patients who underwent unilateral primary ACLR surgery were enrolled. Assessments at 6 and 12 months postoperatively consisted of knee strength testing (isokinetic quadriceps and hamstring strength), the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF), and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale to measure psychological readiness to RTS. Patients were assigned to 1 of 3 subgroups based on their subjective assessment of RTS level at 12 months postoperatively: RTS at or above preinjury level (RTS≥Pre; n = 19), RTS below preinjury level (RTS

Results

Significant differences were found among the RTS≥Pre, RTS

Conclusion

The ACL-RSI score was significantly different among the study groups, and the ACL-RSI score at 12 months postoperatively and younger age were associated with RTS at or above preinjury level.

Collapse

Key Words

• ACL-RSI
• knee strength
• patient-reported knee function
• performance

Collapse

MESH Headings Collapse

Grants Collapse

Affiliation(s)

Makoto Suzuki Faculty of Health Sciences, Hokkaido University, Sapporo, Japan Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan
Tomoya Ishida Faculty of Health Sciences, Hokkaido University, Sapporo, Japan Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan
Hisashi Matsumoto Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan
Satoru Kaneko Department of Orthopaedic Surgery, Hokushin Orthopaedic Hospital, Sapporo, Japan
Chiharu Inoue Department of Orthopaedic Surgery, Hokushin Orthopaedic Hospital, Sapporo, Japan
Yoshimitsu Aoki Department of Orthopaedic Surgery, Hokushin Orthopaedic Hospital, Sapporo, Japan
Harukazu Tohyama Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
Mina Samukawa Faculty of Health Sciences, Hokkaido University, Sapporo, Japan

Collapse

Responsiveness of the Indonesian Versions of the Anterior Cruciate Ligament-Return to Sport After Injury Score, the International Knee Documentation Committee Subjective Knee Form, and the Lysholm Score in Patients With ACL Injury

Background

The Indonesian versions of the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI), International Knee Documentation Committee subjective knee form (IKDC), and the Lysholm scores are considered valid and reliable for Indonesian-speaking patients with anterior cruciate ligament (ACL) injury.

Purpose/Hypothesis

The purpose of this study was to determine the responsiveness of the ACL-RSI, IKDC, and Lysholm scores in an Indonesian-speaking population with ACL injury. It was hypothesized that they would have good responsiveness.

Study Design

Cohort study (diagnosis); Level of evidence, 2.

Methods

Between March 1, 2021, and February 28, 2022, patients with an ACL injury at a single hospital in Indonesia were asked to complete the ACL-RSI, IKDC, and Lysholm scores before either reconstruction surgery or nonoperative treatment. At 6 months after treatment, the patients completed all 3 scores a second time, plus a global rating of change question. The distribution-based and the anchor-based methods were used to study responsiveness. For each scale, the standardized response mean, minimal clinically important difference (MCID), and minimal detectable change (MDC; at the group [MDCgr] and individual [MDCind] levels) for each scale were determined.

Results

Of 80 eligible patients, 75 (93.8%) completed the study. The standardized response means for the ACL-RSI, IKDC, and Lysholm scores were 1.59, 1.72, and 1.51, respectively, indicating good responsiveness. The MCIDs for the ACL-RSI, IKDC, and Lysholm scores were 6.8, 7.8, and 4.8, respectively; all MCIDs were larger than that of the MDCgr (1.1, 0.7, and 0.6, respectively). At the individual level, the MCID for the IKDC was larger than the MDCind (7.8 vs 5.8). However, the MCIDs for ACL-RSI and Lysholm scores were smaller than those of the MDCind (6.8 vs 10.9 and 4.8 vs 5.1, respectively).

Conclusion

The Indonesian ACL-RSI, IKDC, and Lysholm scores indicated good responsiveness and can be used in the follow-up of patients after ACL injury, especially at the group level. In individual patients, IKDC was found to be more efficient than the ACL-RSI or Lysholm scores for detecting clinically important changes over time after ACL treatment.

Translation, Validity, and Reliability of the Indonesian Version of the Anterior Cruciate Ligament-Return to Sport After Injury Scale

Background

The Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale measures athletes' emotion, confidence, and risk appraisal when returning to sports after an anterior cruciate ligament (ACL) injury and/or ACL reconstruction (ACLR).

Purpose

To translate the ACL-RSI into the Indonesian language and to assess its validity and reliability in Indonesian-speaking patients after ACLR.

Study Design

Cohort study (diagnosis); Level of evidence, 2.

Methods

After a forward-and-backward translation procedure, the validity and reliability of the Indonesian version of the ACL-RSI (I-ACL-RSI) were investigated. Patients who had undergone ACLR at a single hospital were asked to complete 4 questionnaires: I-ACL-RSI, Injury-Psychological Readiness to Return to Sport, Tampa Scale of Kinesiophobia, and International Knee Documentation Committee. After a 2-week interval, patients were asked to complete the I-ACL-RSI a second time. Following the COSMIN reporting guidelines (Consensus-Based Standards for the Selection of Health Measurement Instruments), we determined construct validity using hypothesis testing, as well as test-retest reliability, internal consistency, floor and ceiling effects, and measurement error.

Results

Of 200 eligible patients, 102 (51%) were included in the analysis. All predefined hypotheses on correlations between the I-ACL-RSI and the other questionnaires were confirmed, indicating good construct validity. An intraclass correlation coefficient of 0.90 (2-way random, type agreement) was found for the first and second I-ACL-RSI scores, indicating good test-retest reliability. A Cronbach α of 0.95 indicated good internal consistency, and no floor or ceiling effects were found. The standard error of measurement was 3.9, with the minimal detectable change calculated as 10.9 points at the individual level and 1.1 points at the group level.

Conclusion

Based on the study findings, the I-ACL-RSI can be considered a valid and reliable questionnaire for Indonesian-speaking patients after ACL injury and/or ACLR.

Relationships between Jumping Performance and Psychological Readiness to Return to Sport 6 Months Following Anterior Cruciate Ligament Reconstruction: A Cross-Sectional Study

Background: Investigating the relationship between functional capacity and psychological readiness is of paramount importance when planning sport resumption following knee surgery. The aim of this study was to prospectively assess clinical and functional outcomes in athletes 6 months after primary anterior cruciate ligament (ACL) reconstruction and to evaluate whether jumping ability is related to psychological readiness to return to sport following ACL surgery. Methods: Patients who underwent ACL reconstruction were prospectively enrolled and evaluated pre-operatively and 6 months after surgery. Assessment included Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner activity level, and the ACL−Return to Sport after Injury (ACL-RSI) scale. Jumping ability was instrumentally assessed by an infrared optical acquisition system using a test battery including mono- and bipodalic vertical jump and a side hop test. Patients were dichotomized by ACL-RSI into two groups: group A (ACL-RSI > 60), and group B (ACL-RSI < 60). Results: Overall, 29 males and two females from the original study group of 37 patients (84%) were available for clinical evaluation. Mean age at surgery was 34.2 years (SD 11.3). Mean body mass index (BMI) was 25.4 (SD 3.7). Mean overall Lysholm, IKDC, and ACL-RSI scores increased from pre-operatively (p < 0.001). No differences in Tegner score were reported (p = 0.161). Similarly, improvement in most variables regarding jumping ability were observed at follow-up (p < 0.05). According to ACL-RSI, 20 subjects were allocated in group A (ACL-RSI > 60), while 11 were allocated in group B (ACL-RSI < 60). A statistically significant difference in favor of patients in group A was recorded for the post-operative Lysholm and Tegner score, as well as Side Hop test LSI level (p < 0.05), while a trend for IKDC was observed without statistical significance (p = 0.065). Conclusions: Patients with higher values of ACL-RSI scores showed better functional and clinical outcomes as well as improved performance 6 months after ACL reconstruction

Return to Sport After Revision ACL Reconstruction: A Comparative Cohort Study of Outcomes After Single- Versus Multiple-Revision Surgeries

BACKGROUND

The return-to-sport rate at 2 years after multiple-revision anterior cruciate ligament (ACL) reconstructions has not been evaluated.

HYPOTHESIS

It was hypothesized that patients who undergo multiple-revision ACL reconstructions would have a lower return-to-sport rate at 2 years after surgery than those who undergo a single-revision reconstruction. Furthermore, it was hypothesized that the multiple-revision group would have lower functional scores.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

A single-center cohort study in patients who underwent revision ACL reconstruction was begun in 2012. This study included 2 groups: Patients who underwent a single revision, and those who underwent multiple revisions. The main evaluation criterion was the return to sport at the 2-year follow-up. The secondary criteria were the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, and ACL-Return to Sport after Injury (ACL-RSI) functional knee scores at the 1- and 2-year follow-ups.

RESULTS

A total of 322 patients (single-revision group: n = 302; multiple-revision group: n = 20) were included. A significant difference in the percentage of patients who stopped all sports activity was found between the 2 groups at 2 years (single-revision group: 19.4%; multiple-revision group: 50%). The return-to-sport rate at the same or lower level of performance was higher in the single-revision group as well (17% vs 14.3% for return at the same level; 45.6% vs 14.3% for return at a lower level; P = .03). At the 2-year follow-up, the functional scores of the single-revision group were significantly higher those than in the multiple-revision group: IKDC (77.7 ± 13.82 vs 64.79 ± 15.22; P < .001), KOOS (72.66 ± 17.63 vs 52.5 ± 15.64; P < .001), Lysholm (84.05 ± 11.88 vs 72.5 ± 13.49; P < .001), and ACL-RSI (52.34 ± 21.83 vs 46.43 ± 14.8; P = .0036).

CONCLUSION

Only a small percentage of patients returned to the same level of sport after single- revision and multiple-revision ACL reconstruction, yet significantly more in the former. More patients who underwent multiple revisions gave up their sport. Functional scores were higher for single-revision than multiple-revision surgeries.

Cross-sectional study on relationships between physical function and psychological readiness to return to sport after anterior cruciate ligament reconstruction

BACKGROUND

Information about specific factors of physical function that contribute to psychological readiness is needed to plan rehabilitation for a return to sports. The purpose of this study was to identify specific physical functions related to the psychological readiness of patients aiming to return to sports 6 months after reconstruction. We hypothesized that the knee strength is a factor related to the Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI) cutoff score for a return to sports.

METHODS

This was a cross-sectional study. Fifty-four patients who had undergone primary reconstruction using hamstring tendon participated in this study. Psychological readiness was measured using the ACL-RSI in patients at 6 months after reconstruction. To identify specific physical functions related to the ACL-RSI score, participants were divided into groups with ACL-RSI scores of ≥ 60 or < 60. Non-paired t-tests or the Mann-Whitney test were performed to analyze group differences in objective variables in physical function: (1) knee strength in both legs; (2) leg anterior reach distance on both sides; and (3) single-leg hop (SLH) distances in three directions for both legs.

RESULTS

Significant differences between groups were identified in knee flexion strength (60°/s) for the uninvolved limb, hamstring-to-quadriceps ratio (60°/s) for the uninvolved limb, knee flexion strength (180°/s) for the involved limb, limb symmetry index (LSI) of leg anterior reach distance, the ratio of the distance to the height of the patient and LSI of SLH distances in lateral and medial directions.

CONCLUSION

This study revealed that at 6 months after reconstruction, increased knee flexion strength (ratio of peak torque measured to body mass of the patient), hamstring-to-quadriceps ratio, leg anterior reach distance LSI, and lateral and medial SLH appear important to exceed the ACL-RSI cutoff for a return to sports. The present results may be useful for planning post-operative rehabilitation for long-term return to sports after reconstruction.

Arabic Version of the Short Anterior Cruciate Ligament-Return to Sport After Injury Scale: Translation, Cross-cultural Adaptation, and Validation

Background:

The short version of the Anterior Cruciate Ligament–Return to Sport After Injury (ACL-RSI) scale is a self-reported questionnaire developed to assess the psychological readiness of patients to return to sports after ACL reconstruction (ACLR).

Purpose:

To translate, cross-culturally adapt, and validate the short version of the ACL-RSI scale into the Arabic language (ACL-RSI-Ar).

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

The original short version of the ACL-RSI scale was forward and backward translated, cross-culturally adapted, and validated following international standardized guidelines. Sixty patients who participated in sports activities and underwent ACLR completed the ACL-RSI-Ar, the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and Knee injury and Osteoarthritis Outcome Score (KOOS) scales. To assess test-retest reliability, 34 participants completed the ACL-RSI-Ar scale twice. Statistical tests were conducted to test the internal consistency, reliability, and construct and discriminant validity of the ACL-RSI-Ar scale.

Results:

The ACL-RSI-Ar showed adequate internal consistency (Cronbach alpha = 0.734) and excellent test-retest reliability (intraclass correlation coefficient, 0.871). The ACL-RSI-Ar was strongly correlated with the IKDC (Spearman ρ = 0.515, P < .001) and weakly to strongly correlated with all KOOS subscales (Spearman ρ = 0.247-0.590, P < .05). Patients who returned to sports had significantly higher scores on the ACL-RSI-Ar scale when compared with those who did not return to sports (P = .001).

Conclusion:

The short ACL-RSI-Ar scale, as translated, was internally consistent, reliable, and valid for evaluating psychological readiness to return to sports after ACLR in Arabic-speaking patients.

The psychological readiness to return to sports of patients with anterior cruciate ligament reconstruction preoperatively and 6 months postoperatively

OBJECTIVE

To determine the association of psychological readiness to return to sports preoperative and 6 months post-reconstruction in athletes with anterior cruciate ligament (ACL) injury.

DESIGN

Retrospective cohort study.

SETTING

Clinical center of sports medicine.

PARTICIPANTS

Fifty athletes, aged 16-45 years, were included in this study. Participants had a modified Tegner activity scale score ≥5 before ACL injury.

MAIN OUTCOME MEASURES

Participants were divided into High and Low groups based on ACL-return to sport after injury scale (ACL-RSI) scores 6 months post-ACL reconstruction (ACLR) (cutoff: 56 points).

RESULTS

The Low group had lower ACL-RSI scores than the High group preoperatively (P < 0.001) and 6 months post-ACLR (P < 0.001). The High group had a significantly greater amount of change in ACL-RSI scores preoperatively to 6 months post-ACLR than the Low group (P = 0.003). Preoperative ACL-RSI scores increased significantly to 6 months post-ACLR in the entire group of participants (P < 0.001) and in the High group (P < 0.001). However, in the Low group, ACL-RSI scores did not increase significantly (P = 0.714).

CONCLUSIONS

Participants with low ACL-RSI scores 6 months post-ACLR had low preoperative ACL-RSI scores that did not improve preoperatively to 6 months post-ACLR.

Patient function in serial assessments throughout the post-ACL reconstruction progression

OBJECTIVE

To assess the changes in patient strength and function from 4- to 6-month assessments following ACLR, determine relationships between changes in strength to changes in subjective function, and identify factors that predict patients that fail to increase in strength.

DESIGN

Prospective, Cohort Study.

SETTING

Controlled Laboratory.

PARTICIPANTS

Forty-seven patients(27 female, 24.3 ± 11.1 years) completed a battery of performance assessments at approximately 4- and 6-months following primary ACLR (4.03 ±0 .49 and 6.46 ±0 .68 months).

MAIN OUTCOME MEASURES

Subjective scores and isokinetic knee flexor and extensor strength were compared across visits. Patients were categorized per their ability to increase in strength beyond a previously defined threshold(0.22 Nm/kg). Binary logistic regression models were used to determine predictors of patients that failed to meet strength changes.

RESULTS

Patients demonstrated improvements in patient-reported outcomes and strength measures between visits(P's < 0.05). Higher age (B = -0.073, P = .039), lower pre-injury activity levels (B = 0.61, P = .022), and higher limb symmetry indexes (B = -0.044, P = .05) at 4-months were predictors of patients that did not achieve improvements in quadriceps strength between assessments.

CONCLUSIONS

From 4- to 6-months post-ACLR, increases in subjective function, strength and symmetry were observed. High quadriceps symmetry at interim assessments without consideration of the magnitude of strength values could overestimate recovery of quadriceps function.

Patient-Reported Outcomes, Return-to-Sport Status, and Reinjury Rates After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes: Minimum 2-Year Follow-up

Background

Significant variation exists in the published rates of return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR). Functional outcomes and psychological response to injury have been implicated as factors that influence return to sport. Most studies focus on patients aged in the mid-20s, and less is known about this topic in adolescents.

Purpose

To report midterm ACLR results for adolescent patients with regard to return to primary sport, patient-reported outcomes, and reinjury rate.

Study Design

Case-control study; Level of evidence, 3.

Methods

Adolescent athletes were contacted at a minimum of 2 years after ACLR. Patients completed 2 patient-reported outcome measures, the ACL--Return to Sport After Injury (ACL-RSI) and the International Knee Documentation Committee (IKDC) subjective form, and responded to questions regarding preinjury primary sport and level of competition, post-ACLR return to primary sport status, and reinjury.

Results

A total of 74 patients (mean ± SD surgical age, 15.9 ± 1.5 years; follow-up age, 19.9 ± 2.0 years; response rate, 24.5%) completed the surveys at a mean of 4.0 ± 2.0 years after primary ACLR. Outcome scores averaged 90.3 ± 12.3 for IKDC and 81.6 ± 20.4 for ACL-RSI. Questionnaire responses indicated that 27.0% of patients did not return to or sustain primary sport participation after ACLR; the principal reasons were poor knee function, team/training change, and fear of another injury. Both IKDC and ACL-RSI scores were statistically lower in patients who did not successfully return to their primary sport in contrast to patients who successfully resumed their primary sport (IKDC, P = .026; ACL-RSI, P < .001). IKDC and ACL-RSI scores were moderately positively correlated with one another (r _Spearman = 0.60). There were 18 patients (reinjury rate, 24.3%) who suffered another ACL injury; 8 of these injuries included ipsilateral ACL graft tear (retear rate, 10.8%).

Conclusion

In our cohort, 73% of adolescent patients successfully returned to their primary preinjury sport at a minimum of 2 years after ACLR. Both knee function and psychological responses to injury were important in determining an adolescent athlete's return to sport. The findings support the use of the IKDC and ACL-RSI at midterm follow-up, with higher scores associated with a greater likelihood of adolescent patients returning to sport after ACLR.

Factors Associated With Psychological Readiness to Return to Sports With Cutting, Pivoting, and Jump-Landings After Primary ACL Reconstruction

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.

Anterior cruciate ligament-return to sport after injury scale: validation of the Norwegian language version

PURPOSE

Evidence is emerging on the importance of psychological readiness to return to sport after anterior cruciate ligament (ACL) reconstruction. The ACL-Return to Sport after Injury scale (ACL-RSI) is developed to assess this. The aim of the current study was to translate ACL-RSI into Norwegian and examine the measurement properties of the Norwegian version (ACL-RSI-No).

METHODS

ACL-RSI was translated according to international guidelines. A cohort of 197 ACL-reconstructed patients completed ACL-RSI-No and related questionnaires nine months post-surgery. One hundred and forty-six patients completed hop tests and 142 patients completed strength tests. Face and structural validity (confirmative factor analysis and explorative analyses), internal consistency [Cronbach's alpha (α)], test-retest reliability [Intraclass Correlation Coefficients (ICC)], measurement error [Standard error of measurement (SEM) and smallest detectable change at individual (SDC_ind) and group level (SDC_group)] and construct validity (hypotheses testing; independent t tests, Pearson's r) were examined.

RESULTS

ACL-RSI-No had good face validity. Factor analyses suggested that the use of a sum score is reasonable. Internal consistency and test-retest reliability were good (α 0.95, ICC 0.94 (95% CI 0.84-0.97) and measurement error low (SEM 5.7). SDC_ind was 15.8 points and SDC_group was 2.0. Six of seven hypotheses were confirmed.

CONCLUSIONS

ACL-RSI-No displayed good measurement properties. Factor analyses suggested one underlying explanatory factor for "psychological readiness"-supporting the use of a single sum score. ACL-RSI-No can be used in the evaluation of psychological readiness to return to sport after ACL injury.

LEVEL OF EVIDENCE

III.