Age and sex differences in anterior cruciate ligament–return to sport after injury subscale scores of emotion, risk appraisal, and confidence after ACL reconstruction

Review written by Sam Blanchard info

Key Points

  1. Teen athletes reported significantly higher overall ACL-Return to Sport after Injury (ACL-RSI) scores and greater confidence subscale scores compared to adults, suggesting adolescents feel more psychologically prepared to return to sport than their older counterparts.
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BACKGROUND AND OBJECTIVE

Research on anterior cruciate ligament (ACL) injuries has largely focused on biological healing and physical outcomes, with less emphasis on psychological readiness. Nearly 45% of young athletes with an ACL injury do not return to competitive sport, and 65% of these cite psychological barriers, such as fear of reinjury.

The ACL-Return to Sport after Injury (ACL-RSI) scale is a valid tool for assessing psychological readiness after ACL reconstruction. Age and sex influence outcomes, with adolescents and males reporting greater readiness. While total scores are commonly used, the independent subscales - emotion, risk appraisal, and confidence - remain underexplored in clinical practice.

Nearly 45% of young athletes with an ACL injury do not return to competitive sport, and 65% of these cite psychological barriers, such as fear of reinjury.
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Clinicians should view return to sport as a continuum with ongoing physical and psychological monitoring, rather than a simple “cleared” or “not cleared” decision.

METHODS

  • This multisite study utilized data from the ACL Reconstruction Rehabilitation Outcomes Workgroup (ARROW) clinical outcomes registry. Eligible participants were six to 12 months post-unilateral, primary ACL reconstruction (ACLR), aged 14 to 30 years. They were grouped by chronological age as
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