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

Rahimi Khoygani M, Esmaeili H. · Sports health · 2026

This study examined whether absolute hop test performance combined with psychological readiness scores could better predict which professional athletes would reinjure their ACL after surgery compared to traditional limb symmetry index (LSI) measurements. The researchers found that 7 of 10 hop tests showed meaningful side-to-side differences and that absolute hop performance combined with the ACL-RSI psychological scale were more sensitive at identifying reinjury risk than LSI alone, with LSI showing limited discriminatory value.
Takeaway: Use absolute hop test performance metrics alongside the ACL-RSI psychological readiness scale rather than relying on limb symmetry index percentages when deciding if an athlete is ready to return to sport after ACL surgery.
Abstract (source)

Background: Return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction (ACLR) depends on both physical performance and psychological readiness. Although functional tests and patient-reported outcome measures (PROMs) are used widely, the most sensitive and clinically relevant criteria for predicting safe RTS and reducing reinjury risk in elite athletes remain unclear. Hypothesis Absolute hop performance metrics, combined with psychological readiness scores, will more accurately discriminate reinjury risk than traditional limb symmetry index (LSI) thresholds in professional athletes after ACLR.

Study design: Prospective cohort with nested retrospective matched case-control

Design: . Level of evidence Level 2.

Methods: A total of 127 professional athletes completed standardized testing (2021 to 2024) comprising 10 functional hop tests and 3 PROMs, including the ACL-RTS after Injury (ACL-RSI) scale. Reinjury outcomes were tracked for 3 years. In the nested case-control analysis, 32 athletes with noncontact graft reinjury were matched with 32 injury-free ACLR controls. Between-group differences in hop performance, LSI, and PROM scores were analyzed.

Results: Of the 10 hop tests, 7 showed significant side-to-side differences in absolute performance ( P = 0.01-0.04). LSI had limited discriminatory value, with only 1 significant

Result: among female athletes ( P = 0.03). Strong and significant correlations were found between hop performance and ACL-RSI scores ( r = 0.43-0.73; P

Conclusion: Absolute hop performance measures combined with PROMs are more sensitive than LSI in detecting elevated reinjury risk. The ACL-RSI scale may help determine readiness for high-demand functional testing and safe RTS. Clinical relevance Incorporating absolute hop performance metrics with psychological readiness assessment may improve RTS decision-making and reduce reinjury risk in elite athletes.

Observational / cohortWomen's & Youth Athletics
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