Abstract
BACKGROUND: Psychological readiness after anterior cruciate ligament reconstruction (ACLR), as measured by the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale, has become a critical factor in determining an athlete's ability to return to sport. While the ACL-RSI is widely used, the influence of the timing of its administration in relation to physical performance testing has not been studied. PURPOSE/HYPOTHESIS: The primary aim of this study was to investigate the differences in ACL-RSI scores and subscale scores assessed up to one week before versus immediately after exposure to objective physical performance testing, but prior to reviewing the results with the athlete. STUDY DESIGN: Prospective case series. METHODS: Fifty athletes recovering from ACLR participated in this study. The ACL-RSI questionnaire was administered within one week prior to and immediately after completing a return-to-sport physical performance testing battery. The testing included elements assessing maximum volitional force production, explosiveness, and hopping and landing ability. Changes in overall ACL-RSI scores and its subscales (emotions, confidence in performance, and risk appraisal) were analyzed. RESULTS: No significant differences were found in ACL-RSI scores pre- to post return to sport testing (-2.27, p=0.125). However, there was a significant decrease in the emotions subscale (-5.08, p=0.006), suggesting that physical testing may negatively impact emotional readiness. The confidence in performance and risk appraisal subscales did not show significant changes. Despite no statistical differences in ACL-RSI scores pre- to post return to sport testing, 20% of participants exhibited a change in ACL-RSI scores that exceeded the minimal clinically important difference (MCID), highlighting individual variability in psychological responses to testing. CONCLUSION: The findings suggest that administering the ACL-RSI after physical performance testing may provide a more accurate assessment of some athletes' psychological readiness to return to sport. The significant reduction in the emotions subscale underscores the need for further research into the emotional impact of physical testing. LEVEL OF EVIDENCE: 3b.