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Development and Validation of a Short Version of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale
Open accessAbstract
Background: The Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale was developed to measure an athlete’s psychological readiness to return to sport after anterior cruciate ligament (ACL) injury and reconstruction surgery. The scale is being used with increasing frequency in both research and clinical settings. Purpose: To generate and validate a short version of the ACL-RSI scale. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The ACL-RSI scale was administered to 535 patients who had undergone ACL reconstruction surgery. Reliability (Cronbach alpha) was determined and factor analysis of the full scale was undertaken along with a process of item selection and elimination. A second group of 250 patients participated in a predictive validation analysis. This group completed the ACL-RSI scale at 6 months and reported return-to-sport outcomes 12 months following ACL reconstruction surgery. The predictive validity of both scales (full and short versions) was assessed by use of receiver operating characteristic (ROC) curve statistics. Results: The scale was found to have high internal consistency (Cronbach alpha, 0.96), which suggested that item redundancy was present. After an item selection process, the scale was reduced to a 6-item format. Cronbach alpha for the short version was 0.92, and factor analysis confirmed the presence of 1 factor accounting for 71% of the total variance. Scores for the short version were significantly different between patients who had and those who had not returned to sport. Six-month ACL-RSI scores for both the full and short versions had fair to good predictive ability for 12-month return-to-sport outcomes (full version: area under ROC curve, 0.77 [95% CI, 0.7-0.8]; short version: area under ROC curve, 0.75 [95% CI, 0.7-0.8]). Conclusion: A 6-item short version of the ACL-RSI scale was developed from a large cohort of patients undergoing ACL reconstruction. The short version appears to be as robust as the full version for discriminating between and predicting return-to-sport outcomes. The short version of the ACL-RSI may be of use in busy clinical settings to help identify athletes who may find return to sport challenging.
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The selected time window (3-12 months post-ACLR) reflects a critical period in rehabilitation where patients are commonly assessed for return-to-activity decisions.
“The selected time window (3–12 months post-ACLR) reflects a critical period in rehabilitation where patients are commonly assessed for return-to-activity decisions.”
From Biopsychosocial profiles following ACL reconstruction: A latent class analysis of barriers to return-to-activity (2025) · cites this paper as [56]
The Methods (Participants; page unavailable) describe criteria for running at 12 weeks, noncontact training at 6 months, and return to play at 9 months. The Methods (Procedures and Analysis; page unavailable) also assess psychological readiness at 6 months and return-to-sport status at 12 months. These passages support the relevance of the 3–12-month window in this study, but do not establish that patients are commonly assessed throughout that window or explicitly characterize it as a critical rehabilitation period. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe ACL-RSI and TSK-11 are commonly used to assess psychological readiness and kinesiophobia after ACL reconstruction, respectively.
“The Anterior Cruciate Ligament–Return to Sport After Injury Scale (ACL-RSI) and the TSK-11 are commonly used to assess psychological readiness and kinesiophobia after ACLR, respectively (Woby et al., 2005; Webster et al., 2008; Webster and Feller, 2018; Cirrincione et al., 2023).”
From The relationship between psychological readiness to return to sport and kinesiophobia in teens and young adults after anterior cruciate ligament reconstruction (2025) · cites this paper as Webster and Feller, 2018
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Brinlee, A. W., Dickenson, S. B., Hunter-Giordano, A., & Snyder-Mackler, L. (2022) · Sports Health A Multidisciplinary Approach · doi:10.1177/19417381211056873 · Cited by 212
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Metadata
- Authors
- Webster, K. E., & Feller, J. A.
- Affiliations
- La Trobe University (AU)
- Epworth Hospital (AU)
- Corresponding author
- Webster, Kate E.
- Venue
- Orthopaedic Journal of Sports Medicine
- Publisher
- SAGE Publications
- Published
- 2018-04-01
- Volume
- 6
- Issue
- 4
- Pages
- 2325967118763763-2325967118763763
- ISSN
- 2325-9671 (ISSN-L)
- PMC
- PMC5894922
- OpenAlex
- W2796121079
- Cited by
- 211
- References
- 0
- Citations by year
- 2026: 33 · 2025: 37 · 2024: 36 · 2023: 32 · 2022: 32 · 2021: 16 · 2020: 14 · 2019: 10 · 2018: 1
- FWCI
- 10.58
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Orthopaedic Journal of Sports Medicine (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by-nc-nd)
- La Trobe University
- Topics
- Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
- Social Sciences › Psychology › Developmental and Educational Psychology › Sport Psychology and Performance
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Foot and Ankle Surgery
- Keywords
- ACL-RSI scale, anterior cruciate ligament injury, anterior cruciate ligament reconstruction, return to sport, psychological readiness, short-form scale development, scale validation, predictive validity, athletes, psychometric properties
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