ACL Tears: Being Mentally Ready to Return to Sport
Maybe the most well-known injury in sports is the ACL (anterior cruciate ligament) tear and for good reason with over 120,000 ACL tears per year in the United States.(2) After an intensive surgical reconstruction, the recovery can be a physically, mentally, and emotionally draining experience. Unfortunately, not all athletes return to their sport at the same level. This is a challenging injury that can end careers, ruin chances for college scholarships, and cost athletes years of hard work and dedication. A 2014 study found only 46%-63% of patients returned to competitive sports after an ACL tear.(3) A 2011 study found 5.8% of patients re-tore the ACL in the same knee and 11% of patients re-tore in the opposite knee.(4)
A crucial step in the process is deciding when an athlete is ready to return to sport. A popular method of return to sport testing includes a variety of single leg hop tests during which the athlete performs a series of hops that are measured for distance or time. Often the measured values are compared to the non-involved limb. This value is referred to as limb symmetry index (LSI).
Several examples include:
Single hop for distance
Triple hop for distance
6-meter timed hop
Crossover hop for distance
70% of ACL tears are non-contact, occurring during movements including landing from a jump, cutting, and change of direction.
These injuries occur in the absence of any collision or tackle, and they occur during movements likely performed millions of times prior with no issues. It’s an injury often due to the athlete’s biomechanics. Screening for these faulty mechanics and participating in a sport specific injury prevention program can be career saving in preventing these catastrophic injuries.
The ACL- Return to Sport Index (ACL-RSI) is a validated questionnaire that quantifies psychological readiness to return to sport and provides insight into the athlete’s fear of re-injury.(5) Imagine you are an athlete running for a ball. You stop and change direction, a mindless task you’ve done thousands of times. Suddenly, your ACL snaps, your knee buckles, and you fall to the ground in immense pain. You then spend the first few months trying just to walk normally. From every moment then on, you can’t shake the feeling that your knee may snap at any time. Now your expected to run, cut, change direction, jump, or do any sport movement. It’s easy to understand how psychological readiness is such a huge component to a successful return to play program.
Authors of a recently published study demonstrate the relationship between psychological readiness and physical readiness to return to sport. The article,. “Hop to It! The Relationship Between Hop Tests and The Anterior Cruciate Ligament – Return to Sport Index After Anterior Cruciate Ligament Reconstruction in NCAA Division 1 Collegiate Athletes” by Zarro et al (2023), was published in the International Journal of Sports Physical Therapy.
A strong correlation was demonstrated between the ACL-RSI and the limb symmetry index (LSI) for the single hop for distance, and a moderate correlation between the ACL-RSI and the LSI for the triple hop for distance, cross-over hop for distance, and a single leg vertical hop.(1) The crossover hop for distance was a significant predictor for the ACL-RSI.(1) This means performance on these tests will likely pair with psychological readiness to return to sport. Specifically, performance on the crossover hop for distance can predict how well a patient scores on the ACL-RSI.
All of these hops demand the patient to perform deceleration at the knee, a key component of sport specific movmenets including change of direction, cutting, and landing from a jump. It makes sense that if a patient can perform these well, they have confidence in their knee during these movements. The cross over hop involves some lateral and rotational movement and is the most complex of the hop tests; thus, it makes sense it would be the strongest predictor of the patients confidence to return to sport reflected in the ACL-RSI.
If you’ve had an ACL tear or any significant injury and are in need of the transition from rehab to performance, we specialize in the return to play process.
Schedule a physical therapy session with us today to get back to your sport ready to meet your sport specific and position specific demands.
References
1. Zarro M, Dickman M, Hulett T, et al. Hop to It! The Relationship Between Hop Tests and The Anterior Cruciate Ligament – Return to Sport Index After Anterior Cruciate Ligament Reconstruction in NCAA Division 1 Collegiate Athletes. IJSPT. Published online October 1, 2023:1076-1084.
2. Gornitzky AL, Lott A, Yellin JL, Fabricant PD, Lawrence JT, Ganley TJ. Sport-specific yearly risk and incidence of anterior cruciate ligament tears in high school athletes: a systematic review and meta-analysis. Am J Sports Med. 2016;44(10):2716-2723.
3. Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014;48(21):1543-1552.
4. Wright RW, Magnussen RA, Dunn WR, Spindler KP. Ipsilateral graft and contralateral ACL rupture at five years or more following ACL reconstruction: a systematic review. JBJS. 2011;93(12):1159-1165.
5. Sadeqi M, Klouche S, Bohu Y, Herman S, Lefevre N, Gerometta A. Progression of the psychological ACL-RSI score and return to sport after anterior cruciate ligament reconstruction: A prospective 2-year follow-up study from the French Prospective anterior Cruciate Ligament Reconstruction Cohort Study (FAST). Orthop J Sports Med. 2018;6(12):2325967118812819.
Disclaimer: This SciSport blog post is a summary of an article printed in an academic research journal. The purpose of this blog post is to provide readers with academic and educational content in an easy-to-understand format. We take no credit for the material and knowledge presented, and we encourage readers to take a look at the original source provided in the References section.
