Table of Contents
Abstract
The anterior cruciate ligament (ACL) reconstruction process is notoriously challenging, requiring not only rigorous physical rehabilitation but also significant mental resilience. While surgical techniques and physical therapy protocols have advanced considerably, a substantial proportion of Athletes still fail to return to their pre-injury levels of competition despite achieving physical clearance. Recognizing that physical readiness does not automatically equate to psychological readiness, researchers developed the ACL-return to sport after Injury (ACL-RSI) scale. This instrument was specifically engineered to quantify the psychological barriers that Athletes face when contemplating a return to competitive play.
By capturing the nuanced psychological state of the recovering athlete, the ACL-RSI provides a critical missing piece in sports rehabilitation assessment. It allows clinicians to systematically evaluate an athlete's mental readiness, facilitating targeted interventions for those who exhibit high levels of apprehension or low self-efficacy regarding their knee function. The integration of this scale into standard care protocols represents a shift toward a more holistic, biopsychosocial approach to athletic recovery.
📊 Psychometric Scorecard
12
Multidimensional
0.92
📍 Australia
Authors
Purpose
For decades, the success of ACL reconstruction was measured almost exclusively through biomechanical stability and functional strength tests. However, clinical observations and emerging literature highlighted a perplexing trend: many physically rehabilitated Athletes chose to abandon their sports. The ACL-RSI was developed to address this glaring gap in clinical assessment by providing a standardized, empirically backed tool to measure the psychological impact of returning to sport. This is of paramount importance for sports psychologists, orthopedic surgeons, and physical therapists, as it shifts the rehabilitation paradigm from a purely physical focus to a comprehensive model, ensuring that Athletes receive the psychological support necessary for a successful return to play.
Construct
The psychological construct measured by the ACL-RSI is multifaceted, encompassing the cognitive and emotional dimensions of sports resumption following a severe knee injury. The theoretical framework of the scale is built upon three distinct yet interrelated domains: emotional responses, performance confidence, and risk appraisal. The emotional domain captures affective states such as Fear of re-injury and rehabilitation-related frustration. The confidence domain evaluates the athlete's self-efficacy, specifically their trust in the structural integrity of their reconstructed knee and their belief in their ability to perform at pre-injury levels. Lastly, the risk appraisal domain assesses the cognitive evaluation of potential negative outcomes, such as the perceived likelihood of sustaining another injury and the dread associated with undergoing subsequent surgeries.
Validity
In terms of psychometric validation, the initial evaluation of the scale demonstrated robust known-groups validity. The researchers hypothesized that Athletes who had decided to quit their sport would exhibit a more negative psychological profile compared to those who were actively returning. The empirical results strongly supported this, revealing that individuals who abandoned sports participation scored significantly lower on the assessment (p < 0.001). This significant differentiation underscores the instrument's clinical utility in identifying Athletes whose psychological distress may impede their physical return, aligning well with established psychometric standards for predictive and concurrent validity in health psychology.
Reliability
The internal consistency of the instrument was evaluated using a sample of 220 Athletes, yielding a highly favorable Cronbach's alpha coefficient of 0.92. In the realm of psychometric measurement, an alpha value exceeding 0.90 indicates excellent reliability, suggesting that the 12 items are highly cohesive and consistently measure the overarching construct of psychological readiness. This level of precision is particularly advantageous for clinical applications, where high reliability is required to make informed decisions about individual patients' psychological treatment and return-to-play timelines.
Factor Analysis
Subscales
| Subscale | Items | Description |
|---|---|---|
| Emotions | 1, 2, 3, 4, 5 | Measures affective responses to returning to sport, including nervousness, frustration, tension, and Fear of re-injury. |
| Confidence in performance | 6, 7, 8, 9, 10 | Assesses the athlete's self-efficacy regarding their knee stability and their overall ability to perform at pre-injury levels. |
| Risk appraisal | 11, 12 | Evaluates the cognitive assessment of the likelihood of re-injury and the deterrent effect of potentially facing surgery again. |
Instrument
| Test Type | Self-report questionnaire |
| Format | 12 items, 10 cm Visual Analogue Scale |
| Language | English |
| Population | Athletes |
| Age Group | 16-54 |
| Administration | Self-administered |
ACL-Return to Sport after Injury scale Items
Items are currently not available
The individual items of this scale are not publicly available. Researchers interested in using this instrument should contact the original authors directly to request the scale materials.
Sample
The validation sample consisted of 220 Athletes (124 males, 96 females) aged 16 to 54 years (mean = 29.2, SD = 9.7). Participants had undergone ACL reconstruction surgery 8 to 22 months prior to the study (mean = 12 months) and were recruited from a specialist knee orthopedic surgeon's private practice during routine reviews.
Cite This Paper
Kate E. Webster, Julian A. Feller, Christina Lambros (2007). ACL-return to sport after Injury scale. Physical Therapy in Sport. https://doi.org/10.1016/j.ptsp.2007.09.003
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Cite this article
Mohammed looti (2026). ACL-Return to Sport after Injury scale. PSYCHOLOGICAL SCALES. Retrieved from https://scales.arabpsychology.com/s/acl-return-to-sport-after-injury-scale/
Mohammed looti. "ACL-Return to Sport after Injury scale." PSYCHOLOGICAL SCALES, 13 Aug. 2026, https://scales.arabpsychology.com/s/acl-return-to-sport-after-injury-scale/.
Mohammed looti. "ACL-Return to Sport after Injury scale." PSYCHOLOGICAL SCALES, 2026. https://scales.arabpsychology.com/s/acl-return-to-sport-after-injury-scale/.
Mohammed looti (2026) 'ACL-Return to Sport after Injury scale', PSYCHOLOGICAL SCALES. Available at: https://scales.arabpsychology.com/s/acl-return-to-sport-after-injury-scale/.
[1] Mohammed looti, "ACL-Return to Sport after Injury scale," PSYCHOLOGICAL SCALES, vol. X, no. Y, ص Z-Z, August, 2026.
Mohammed looti. ACL-Return to Sport after Injury scale. PSYCHOLOGICAL SCALES. 2026;vol(issue):pages.