Association Between Meeting Return-to-Sport Criteria and Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction

Yuya Ueda; Takehiko Matsushita; Yohei Shibata; Kohei Takiguchi; Kumiko Ono; Akihiro Kida; Rei Ono; Kanto Nagai; Yuichi Hoshino; Tomoyuki Matsumoto; Yoshitada Sakai; Ryosuke Kuroda

doi:10.1177/23259671221093985

Association Between Meeting Return-to-Sport Criteria and Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction

Orthop J Sports Med. 2022 May 10;10(5):23259671221093985. doi: 10.1177/23259671221093985. eCollection 2022 May.

Authors

Affiliations

¹ Kobe University Graduate School of Health Sciences, Kobe, Japan.
² Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan.
³ Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
⁴ Department of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.

Abstract

Background: The relationship between meeting return-to-sport criteria and psychological readiness after anterior cruciate ligament (ACL) reconstruction is unknown.

Purposes: To examine (1) whether patients who met 1 of the criteria for return to sport had higher psychological readiness than those who did not meet any of the criteria and (2) if those who met more criteria had higher psychological readiness.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: This study included 144 patients who underwent unilateral ACL reconstruction. All patients had regularly participated in some sport activities before an ACL rupture. At 12 months postoperatively, each patient completed 3 knee function tests (isokinetic quadriceps strength, isokinetic hamstring strength, and single-leg hop distance) and 2 self-reported measures (International Knee Documentation Committee [IKDC] 2000 subjective form and ACL-Return to Sport after Injury [ACL-RSI] scale); the ACL-RSI scale was used to measure psychological readiness to return to sport. The 4 criteria for return to sport were a limb symmetry index (LSI) ≥90% for each of the 3 function tests in addition to an IKDC score ≥90. Multivariate regression analysis was used to determine the association between meeting the individual criteria and the ACL-RSI score. In addition, the patients were divided into 5 groups according to the number of criteria met, and the Kruskal-Wallis and Steel-Dwass tests were used to compare the ACL-RSI scores among the groups.

Results: Overall, 23 patients (16.0%) met none of the criteria for return to sport, 27 (18.7%) met 1 of the criteria, 34 (23.6%) met 2 criteria, 35 (24.3%) met 3 criteria, and 25 (17.4%) met all 4 criteria. Meeting the criteria for the hamstring strength LSI (P = .002), single-leg hop distance LSI (P = .004), and IKDC subjective score (P < .001) was each associated with higher ACL-RSI scores. Significant differences in ACL-RSI scores were found between patients who met none versus 2, 3, and 4 of the return-to-sport criteria (P < .001 for all) and between patients who met 1 versus 4 criteria (P < .001).

Conclusion: Meeting return-to-sport criteria was positively associated with psychological readiness, and the patients who met multiple criteria had higher psychological readiness.

Keywords: ACL-RSI; anterior cruciate ligament reconstruction; knee function; psychological readiness; return-to-sport criteria.