No Relationship Between Strength and Power Scores and Anterior Cruciate Ligament Return to Sport After Injury Scale 9 Months After Anterior Cruciate Ligament Reconstruction

Am J Sports Med. 2020 Jan;48(1):78-84. doi: 10.1177/0363546519887952.


Background: Psychological factors including self-reported readiness to return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) measured with the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale have been shown to correlate with RTS. Physical deficits have been shown to exist in the later stages after ACLR rehabilitation. No previous studies have investigated the relationship between self-reported readiness to RTS and objective physical measures of power and strength.

Purpose: To investigate the relationship between ACL-RSI scores and measures of strength and power scores after ACLR.

Study design: Case control study; Level of evidence, 3.

Methods: This study recruited 452 male athletes who had undergone primary ACLR. Each athlete completed the ACL-RSI questionnaire, isokinetic strength testing, and jump testing approximately 9 months after surgery.

Results: ACL-RSI scores showed a trivial or weak correlation with strength and power measures at 9 months after surgery (r = 0.06-0.16). Similar results were found for the relationship between ACL-RSI scores and limb symmetry index for strength and power measures (r = 0.04-0.15). Comparing the strength and power measures of athletes with higher (≥90) ACL-RSI scores (n = 93) versus athletes with lower (≤75) ACL-RSI scores (n = 92) showed no significant differences except for isokinetic hamstring strength, but with a trivial effect size (P = .040; effect size = 0.15).

Conclusion: Self-reported readiness to RTS as measured by the ACL-RSI had little or no relationship with athletes' strength and power measures, and there was no meaningful difference in strength and power between athletes with higher and lower ACL-RSI scores at 9 months after ACLR. The findings suggest that psychological recovery and physical recovery after ACLR are different constructs, and strategies to measure and address each construct separately may be necessary to ensure successful RTS after ACLR.

Keywords: anterior cruciate ligament; orthopaedic; physical therapy; psychological aspects of sport; rehabilitation; sport.

MeSH terms

  • Adult
  • Anterior Cruciate Ligament Injuries / surgery*
  • Anterior Cruciate Ligament Reconstruction / rehabilitation
  • Anterior Cruciate Ligament Reconstruction / statistics & numerical data*
  • Case-Control Studies
  • Humans
  • Ireland
  • Male
  • Muscle Strength*
  • Return to Sport / statistics & numerical data*
  • Self Report
  • Young Adult