Progression of the Psychological ACL-RSI Score and Return to Sport After Anterior Cruciate Ligament Reconstruction: A Prospective 2-Year Follow-up Study From the French Prospective Anterior Cruciate Ligament Reconstruction Cohort Study (FAST)

Mansour Sadeqi, Shahnaz Klouche, Yoann Bohu, Serge Herman, Nicolas Lefevre, Antoine Gerometta, Mansour Sadeqi, Shahnaz Klouche, Yoann Bohu, Serge Herman, Nicolas Lefevre, Antoine Gerometta

Abstract

Background: Successful return to sport after anterior cruciate ligament (ACL) reconstruction requires optimal physical and psychological recovery. The main validated tool to quantify a patient's psychological readiness to return to sport after this surgery is the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale.

Purpose: The primary aim was to analyze the progression of the ACL-RSI score from preoperatively to 2-year follow-up. A secondary goal was to identify the factors associated with returning to the same preinjury sport.

Study design: Cohort study; Level of evidence, 2.

Methods: This prospective study included athletes older than 16 years in all sports and levels of play who underwent primary and revision isolated ACL reconstruction from 2012 to 2015 and responded to all study questionnaires at 2-year follow-up. The primary outcome was the ACL-RSI score obtained preoperatively and at 4-month, 6-month, 1-year, and 2-year follow-up. The secondary outcomes were return to sport (running and the same preinjury sport) and various functional scores. The optimal threshold value of the ACL-RSI score for returning to the same preinjury sport was determined with the receiver operating characteristic curve. Multivariate analysis was performed to identify other factors associated with returning to the same sport at 2-year follow-up.

Results: A total of 681 patients were analyzed (467 men, 214 women; mean age, 30.2 ± 9.5 years); 298 (43.8%) patients were professional or competitive athletes. The ACL-RSI score improved significantly over time: 41.3 ± 25.4 preoperatively, 55.1 ± 21.3 at 4 months, 58.3 ± 22.3 at 6 months, 64.7 ± 24.2 at 1 year, and 65.2 ± 25.3 at 2 years (P < .00001). At 2-year follow-up, 74.9% of patients had returned to running and 58.4% to their same preinjury sport. The ACL-RSI score was significantly higher in patients who had returned to sport and in those who returned to the same level of play or higher (P < .00001). The optimal ACL-RSI score threshold to return to the same sport at 2-year follow-up was ≥65. Multivariate analysis showed that the predictive factors of returning to the same preinjury sport at 2-year follow-up were primary reconstruction, professional or competitive level of play, an ACL-RSI score ≥60 at 6-month follow-up, and the absence of postoperative complications.

Conclusion: The psychological ACL-RSI score improved regularly after ACL reconstruction and was strongly and significantly associated with return to sport.

Registration: NCT02511158 (ClinicalTrials.gov identifier).

Keywords: ACL-RSI scale; anterior cruciate ligament reconstruction; psychological score; return to sport.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This research was supported by the Fonds de Dotation pour la Recherche Clinique en Orthopédie et Pathologie du Sport and Ramsay Générale de Santé. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Patient selection. ACL, anterior cruciate ligament; FU, follow-up.
Figure 2.
Figure 2.
Sport practiced at the time of injury.
Figure 3.
Figure 3.
Progression of the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) score (median and range) regardless of return to sport.
Figure 4.
Figure 4.
Optimal Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) score threshold in patients who returned to the same preinjury sport at 2-year follow-up. ROC, receiver operating characteristic.

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