Progression of the ACL-RSI psychological score for return to sports following anterior cruciate ligament reconstruction. Prospective study in 681 athletes after 2 years of follow-up
ESSKA Academy. Gerometta A. May 11, 2018; 218136; FP45-447
Antoine Gerometta
Antoine Gerometta
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Objectives: The return to sports following anterior cruciate ligament (ACL) reconstruction requires optimal physical and psychological recovery. The ACL-RSI (Anterior Cruciate Ligament-Return-to-Sport after Injury) score is the primary tool for overall evaluation of the psychological dimension of recovery. The main goal of this study was to analyze the postoperative progression of the ACL-RSI score. The secondary goal was to identify the factors associated with return-to-sport.

Methods: A prospective single center cohort study was begun in 2012 including all the patients operated for cruciate ligament tears of the knee by four senior surgeons. A retrospective analysis of prospective data included athletes over 16 years of age, all sports and levels combined, operated between 2012 and 2015 for isolated ACL reconstruction and who responded to all questionnaires at 2-year follow-up. All protocols were standardized. The main judgment criterion was the ACL-RSI score evaluated preoperatively and at the 4-month, 6-month, 1-year and 2-year postoperative follow-up. The secondary judgment criteria were the return to sports (running and the usual sport) and the different functional scores (subjective IKDC, KOOS and Lyshom scores). The optimal threshold value of the ACL-RSI was determined with the ROC curve. Multivariate analysis was performed by logistic regression to identify other factors associated with the return to the usual sport 2 years after surgery.

Results: 681 patients were included, 467 men and 214 women, mean age 30.2±9.5 years old. 298 (43.8%) patients were professional or competitive athletes. Most patients practiced pivot-contact sports (63.7%). During follow-up the ACL-RSI score significantly improved (p<0.00001): 41.3±25.4 (preoperative), 55.1±21.3 (4 months), 58.3±22.3 (6-month), 64.7±24.2 (1-year), 65.2±25.3 (2-year). At 2 years of follow-up, 74.9% of patients had returned to running and 58.4% to their usual sport. The ACL-RSI score was significantly higher in those who had returned to sports (p<0.00001) and in patients who returned to a higher or the same level of play (81.6±16.1 vs 53.2±24.1, p< 0.00001). The optimal threshold value of the ACL-RSI score at 2 years was 65% (sensitivity=75.1%, specificity=68.5%, percentage of well classified patients =72.4%). Multivariate analysis showed that the predictive factors of returning to the usual sport at 2 years was primary reconstruction (OR=2.2), professional or competitive level of play (OR=2.7), an ACL-RSI score at 6 months >60% (OR=3.1) and the absence of complications during follow-up (OR=2.5).

Conclusions: Following ACL reconstruction, the psychological ACL-RSI score improves regularly during follow-up and is strongly and significantly associated with the return to sports. Patients with a high level of sports, surgery for primary reconstruction, an absence of postoperative complications and an ACL-RSI score at 6-month of more that 60%, have a significantly higher chance of returning to their usual sport at 2-year follow-up.

ACL reconstruction; ACL-RSI score; return to sports; psychological readiness
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