Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction in the Adolescent Athlete

CONTEXT: Psychological readiness to return to sport has been shown to be associated with future play after anterior cruciate ligament (ACL) reconstruction surgery but has not been extensively studied in adolescent athletes. OBJECTIVE: To investigate the psychometric properties of the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale in adolescent athletes at multiple time points after ACL reconstruction surgery and determine whether psychological readiness scores at 6 months predict return to competition sport at 12 months. DESIGN: Case series. SETTING: Private orthopaedic clinic. PATIENTS OR OTHER PARTICIPANTS: A total of 115 adolescent athletes (65 girls, 50 boys) 17 years and younger who had undergone primary unilateral ACL reconstruction. MAIN OUTCOME MEASURE(S): The ACL-RSI scale was administered at 6 and 12 months after surgery, and return-to-sport status was also documented. Factor analysis was undertaken and predictive validity assessed using between-groups comparisons and receiver operating characteristic (ROC) curve statistics. RESULTS: The ACL-RSI scores increased between 6 and 12 months (55 to 71; P < .001, effect size = 0.98). No floor or ceiling effects were present, and the scale had high internal consistency (Cronbach α at 6 months = 0.91 and at 12 months = 0.94). Principal component analysis showed that 2 factors were present: the first represented performance confidence and risk appraisal and the second, emotions. For the full-scale ACL-RSI, scores at 6 months had acceptable predictive ability for a return to play at 12 months (area under the ROC curve = 0.7, P = .03). When the 2 identified factors were analyzed separately, the emotions factor also had acceptable predictive ability (area under the ROC curve = 0.73, P = .009), but the confidence in performance and risk appraisal factors had poor predictive ability (area under the ROC curve = 0.59, P = .09). CONCLUSIONS: Greater psychological readiness was associated with return to sport in adolescent athletes after ACL reconstruction, with the athletes' emotional response appearing to be more influential than their confidence in their performance or their appraisal of risk.