Five-year ACL-RSI scores are associated with patient-reported outcomes after ACL reconstruction

Psychological factors influence recovery after Anterior Cruciate Ligament (ACL) reconstruction. While the ACL Return to Sport after Injury (ACL-RSI) score is widely used during early follow-up, its clinical relevance at mid-term follow-up remains unclear.

To evaluate the association between ACL-RSI scores measured at approximately five years after ACL reconstruction and patient-reported outcomes at mid-term follow-up.

A retrospective analysis of a prospectively collected cohort was performed. Patients who underwent primary ACL reconstruction between January 2017 and December 2019 and completed the ACL-RSI questionnaire at approximately five-year follow-up were included. Functional outcomes assessed at final follow-up included the subjective International Knee Documentation Committee (IKDC) score, Self Knee Value (SKV), and Tegner activity scale. Associations were analyzed using Spearman correlation coefficients and further assessed using multivariable linear regression models adjusting for potential confounders.

A total of 471 patients were included, with a mean follow-up of 4.9 ± 1.2 years. ACL-RSI scores showed moderate-to-high correlations with IKDC (r = 0.67, p < 0.001) and SKV (r = 0.59, p < 0.001), and a lower correlation with the Tegner activity scale (r = 0.34, p < 0.001). In multivariable analyses, ACL-RSI remained independently associated with all functional outcomes (all p < 0.001). ACL-RSI scores were significantly higher at mid-term follow-up compared with six months postoperatively (70 ± 25 vs 65 ± 19; p < 0.001), corresponding to a modest mean increase of 5 points.

Psychological readiness assessed by the ACL-RSI remains significantly associated with patient-reported knee function and activity level at mid-term follow-up after ACL reconstruction.

IV; retrospective cohort study.