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SportsCohort

Functional and Psychological Predictors of Return to Sport and Reinjury Risk in Professional Athletes After ACL Reconstruction

Sports Health A Multidisciplinary Approach · 11 Sept 2026

Rigour45/100
Clinical53/100
Impact†63/100

† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.

Why it matters

This challenges the common reliance on limb symmetry index for return-to-sport clearance, suggesting absolute performance benchmarks and psychological readiness scores may better flag athletes at risk of ACL graft reinjury.

The evidence

This mixed prospective-retrospective cohort followed 127 professional athletes after ACL reconstruction, comparing 32 who suffered a noncontact graft rupture within 3 years against matched non-reinjured controls using 10 functional hop tests, limb symmetry index (LSI), and patient-reported outcome measures. Absolute hop performance (distance/time) differed significantly between reinjured and non-reinjured athletes on most tests (e.g., lateral hop for distance in males: 104.7 vs 160.0 cm, P<0.001), while LSI showed a significant difference in only one test (TCHD in females, P=0.03). The ACL-RSI psychological readiness score correlated moderately-to-strongly with hop performance (r=0.43-0.73) in both groups, whereas KOOS and IKDC did not correlate with hop tests.

A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.

Why this rigour score?

Nested case-controlDesign starting point: 32.2

45/ 100

Raised the score

  • Adequately powered+6
  • Aligned time zero+2.5

Lowered the score

    No negative adjustments recorded.

    Methods at a glance

    Recorded assessment
    • Confounding adjustmentMatching or stratification
    • Covariate balance confirmedNot reported
    • Outcome assessors blindedNot reported
    • Comparable start of follow-upMet
    • Adequate statistical powerMet
    • Prospective registrationNot reported

    Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.

    See the full score breakdown
    Study design starting point
    32.2
    Aligned time zero
    +2.5
    36-month follow-up
    +1.1
    Adequately powered
    +6
    Consecutive enrolment
    +2.5
    Journal prior (not an observed method)
    +1
    Final rigour score rounded
    45 / 100

    Study design sets the starting point and a ceiling of 72. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.

    Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.

    For journal club

    1.If LSI can mask meaningful deficits, how should surgeons and rehab teams change their return-to-sport clearance criteria for elite pivoting-sport athletes?

    2.Should ACL-RSI screening be incorporated routinely before high-demand functional testing, and how would a low score change the timing or sequence of an athlete's rehabilitation?

    Original publication title

    Functional and Psychological Predictors of Return to Sport and Reinjury Risk in Professional Athletes After ACL Reconstruction

    Read original paper