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OrthoMeasure

Patient-reported outcome measure

ACL-RSI Calculator

Anterior Cruciate Ligament – Return to Sport after Injury scale

The ACL-RSI is a 12-item questionnaire of the psychological readiness to return to sport after anterior cruciate ligament injury — confidence, fear of re-injury and emotional response — with each item rated 0 to 10 and the mean expressed out of 100, where a higher score means greater readiness.

Licence unconfirmed12 items~3 min0–100, higher is better

Returning to sport after ACL injury

Answer each question from 0 to 10 about how you feel about playing your sport. The ends of each scale are shown under the question.

0 = not confident at all, 10 = fully confident.

of 10

0 = extremely likely, 10 = not likely at all.

of 10

0 = extremely nervous, 10 = not nervous at all.

of 10

0 = not confident at all, 10 = fully confident.

of 10

0 = not confident at all, 10 = fully confident.

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0 = extremely frustrating, 10 = not at all frustrating.

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0 = extremely fearful, 10 = no fear at all.

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0 = not confident at all, 10 = fully confident.

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0 = extremely afraid, 10 = not at all afraid.

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0 = all of the time, 10 = none of the time.

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0 = not confident at all, 10 = fully confident.

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0 = not at all relaxed, 10 = fully relaxed.

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What the ACL-RSI score means

ACL-RSI totals run from 0 to 100, where a higher score is better. No severity bands are shown because no cut-offs have been published that we can verify — read the total against the source studies and your own protocol, as described below.

    How the score is calculated

    Stated in full so the calculation can be independently checked, and reproduced by hand if needed.

    Each of the 12 questions is rated from 0 to 10 — or 0 to 100 on a visual analogue scale — where the ends are worded so that the higher number is always the more ready response (for “are you nervous about playing your sport”, 10 is “not nervous at all”), so no item is reverse scored. The 12 ratings are averaged and expressed out of 100, so a mean of 6.5 on the 0 to 10 scale is a score of 65. A higher score indicates greater psychological readiness to return to sport. The questions cover emotions, confidence in performance and risk appraisal.

    Missing data

    No missing-data rule has been published, so a score is shown only when all 12 items are answered.

    Instrument profile

    Developer
    Kate E. Webster, Julian A. Feller and Charlotte Lambros
    Institution
    La Trobe University and OrthoSport Victoria, Australia
    First published
    2008
    Custodian
    The developers
    Items
    12
    Response format
    Eleven-point numerical scale, 0 to 10 per item (a 0 to 100 visual analogue scale is also used)
    Score range
    0 to 100
    Direction
    Higher score = better
    Recall period
    Current feelings about returning to sport
    Completion time
    About 3 minutes
    Age range
    Adolescents and adults who play sport
    Regions
    Knee
    Conditions
    ACL injury, Knee ligament injury, Post-traumatic knee injury
    Procedures
    ACL reconstruction, Return to sport testing, Knee rehabilitation
    Languages
    English, Swedish, French, German, Dutch, Turkish
    Internal consistency
    The developers reported a Cronbach’s alpha of 0.92 in the original 2008 study, which they described as satisfactory reliability.
    Validity
    Developed and preliminarily validated in people returning to sport after ACL reconstruction; it measures psychological readiness, which is not captured by strength or hop testing.
    Responsiveness
    Widely used to follow readiness during rehabilitation. No minimal clinically important difference or return-to-sport cut-off is shown here because we could not verify a published value.

    When to use the ACL-RSI

    Well suited to

    • Assessing psychological readiness alongside strength and hop testing before clearing an athlete to return to pivoting sport after ACL reconstruction.
    • Following confidence and fear of re-injury through rehabilitation.

    Limitations and poor fits

    • As the only criterion for return to sport — it measures readiness of mind, not of the knee.
    • Patients who do not intend to return to sport, for whom the sport-specific questions do not apply.
    • Describing knee symptoms and function: pair it with the KOOS or IKDC, and an activity-level measure such as the Tegner or Marx scale.

    ACL-RSI compared with other instruments

    Instruments measuring a related construct, with the practical difference between them.

    InstrumentItemsRangeWhat it adds
    KOOS420–100The KOOS is a 42-item patient-reported questionnaire that scores knee function as five separate subscales — Symptoms, Pain, Activities of Daily Living, Sport and Recreation, and Quality of Life — each from 0 (extreme problems) to 100 (no problems).
    IKDC180–100The IKDC Subjective Knee Evaluation Form is an 18-item patient-reported questionnaire covering knee symptoms, sports and daily activity and current knee function, whose raw total is transformed to a 0 to 100 score where 100 means no symptoms and no activity limitation — it requires permission from the AOSSM, so the items are not reproduced here.
    Tegner10–10The Tegner Activity Scale is a single-item ordinal ladder that grades a patient's work and sport activity from 0 (sick leave or disability pension because of knee problems) to 10 (national or international elite competitive sport), and is normally recorded twice — the pre-injury level and the current level — so that the drop between them can be reported.
    Marx40–16The Marx Activity Rating Scale measures how frequently a patient runs, cuts, decelerates and pivots in their healthiest state over the past year, scoring each on a 0 to 4 frequency scale for a total of 0 to 16, where a higher score means a more demanding activity level.
    TSK-111111–44The TSK-11 is the 11-item short form of the Tampa Scale of Kinesiophobia, which drops the four reverse-scored items and items 9 and 14 of the original, scores each remaining statement 1 to 4 for a total of 11 to 44, and reads a higher total as more fear of movement and (re)injury.

    Copyright and permitted use

    Published openly because it is the question every clinician and researcher asks before using an instrument, and almost nobody answers it.

    Licence unconfirmedRights holder: Kate E. Webster and colleagues

    The scale is distributed freely for clinical use and is widely translated, but copyright rests with its developers. We have not asked them for written permission, so we cannot say it is free of copyright for every use; if a rights holder objects, the item wording will be removed and the page reduced to a profile.

    References

    1. Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Physical Therapy in Sport. 2008.doi:10.1016/j.ptsp.2007.09.003

    Editorial status

    Not yet reviewedQueued for clinical review by Sam Tuffun, PT, DPT. Sign-off has not taken place — this is a placeholder assignment, not a completed review.