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Return to sport testing after anterior cruciate ligament reconstruction has marginal psychological impact: a randomised controlled trial
  1. Daphne I Ling1,2,
  2. Theresa A Chiaia3,
  3. Polly deMille3,
  4. Robert G Marx1,4
  1. 1 Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
  2. 2 Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
  3. 3 Sports Rehabilitation and Performance Center, Hospital for Special Surgery, New York, New York, USA
  4. 4 Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Dr Daphne I Ling, Hospital for Special Surgery, New York, NY 20021, USA; lingd{at}


Objectives The psychological and physical recovery after anterior cruciate ligament (ACL) reconstruction (ACLR) may or may not occur in parallel. A common scenario is the uninformed athlete who lacks awareness of physical deficiencies and returns to sport prematurely. There is increasing evidence that most patients do not meet return to play criteria at 6 months and physical deficits may still persist 1 year after surgery. We hypothesise that a Quality of Movement Assessment for Return to Sport (QMA-RTS) testing programme may have a negative impact on athletes’ perception of psychological readiness to return.

Methods A total of 30 athletes who had ACLR and underwent the QMA-RTS 4–10 months after ACLR were recruited. They were randomised to one of two groups that both completed a baseline ACL Return to Sport after Injury (ACL-RSI) scale before their QMA-RTS appointment. In the intervention group, participants completed a second ACL-RSI after the QMA-RTS. In the control group, participants completed their second survey before the session. The mean difference in scores between the two groups was compared using an independent samples t-test.

Results The groups were balanced for sex (9/15 female), mean age (16 years) and average time since surgery (6 months). The baseline ACL-RSI scores were not statistically different between groups (4.6 (95% CI −10.6 to 19.8), p=0.54). In the controls, there was an increase in scores (+4.4) between the first and second surveys, while there was a decrease in the intervention group (−3.4). This difference between groups was not statistically significant (7.8 (95% CI −1.7 to 17.3), p=0.10).

Conclusions The QMA-RTS programme did not significantly reduce patients’ mean scores on the ACL-RSI compared with controls. The limited effect on psychological responses may be due to the athletes’ self-awareness of their physical deficits at 6 months after ACLR.

Level of evidence Level II, randomised controlled trial.

  • ACL / PCL
  • rehabilitation/physical therapy
  • repair/reconstruction
  • tears
  • knee
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  • Contributors DIL conducted the statistical analysis and drafted the manuscript. TAC and PdM participated in the study design/coordination, data collection, and provided input for the manuscript. RG conceived the study, participated in the study design and provided input for the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was approved by the Institutional Review Board (IRB number 13116).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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