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

Abstract

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.

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

“…Previous studies investigated the relationship between psychological readiness and functional performance [ 13 , 25 , 26 ]. The ACL-RSI score demonstrated to be a reliable scoring scale while evaluating psychological readiness for return to sports after ACL reconstruction [ 17 , 18 ].…”

“…In the study by McPherson et al, patients who underwent ACL re-rupture trended toward lower ACL-RSI scores [ 19 ], while according to Sadeqi et al, ACL-RSI score ≥ 60 months after surgery is a reliable predictor of return to preinjury sport [ 27 ]. According to the study by Aizawa et al, in our case series, we considered 60 as a cut-off value to evaluate psychologic readiness to return to sport six months after surgery [ 13 ]. Webster et al followed up with 635 athletes 12 months after ACL reconstruction, and observed that greater limb symmetry while performing a single-legged hop for distance positively correlates with the ACL-RSI score [ 26 ].…”

“…Tests measuring muscular power and reactivity through vertical jump are demonstrated to be reliable instruments and useful predictors for the return to sports [ 11 , 12 ]. Horizontal hop tests have been widely adopted to detect functional asymmetries between limbs [ 13 , 14 ], although their usefulness has been questioned as they are demonstrated to overestimate the involved limb’s function following ACL surgery [ 15 , 16 ]. Investigating the relationship between functional capacity and psychological readiness is of paramount importance when planning sport resumption following ACL reconstruction [ 9 ].…”

Drop Jump Performance Improves One Year Following Anterior Cruciate Ligament Reconstruction in Sportsmen Irrespectively of Psychological Patient Reported Outcomes

“…Correlation between jumping ability and subjective perception has been previously analyzed [ 15 , 16 , 17 , 18 ]. According to our findings, 12 months after surgery, weak positive correlation was reported between drop jump LSI and Tegner activity level.…”

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

“…difficulty returning to sport or have low ACL-RSI. 1,7 It should also be kept in mind that the ACL-RSI is an assessment measure that may be influenced by the personality of each patient. In addition, it is not yet clear how to improve ACL-RSI.…”