ACL Return to Sport after Injury Scale 2025

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The ACL - Return to Sport after Injury (ACL-RSI) scale, published in 2008 in Physical Therapy in Sport, was developed in order to measure athletes emotion, confidence, and risk appraisal when returning to sports after an ACL injury and/or reconstructive surgery.
ACL-RSI Scale This 12-item scale is designed to measure psychological readiness to return to sport after ACL injury or reconstruction surgery. It includes 3 domains: emotions, confidence, and risk appraisal. Scores for each item are summed and averaged for a total score between 0 and 100.
The original ACL-RSI questionnaire consists of 12 items that evaluate three components, which correlate to RTS in the literature: Five questions on emotional well-being, five questions on confidence in performance, and two questions on risk appraisal. These are evaluated on a Likert scale from 0 to 100.
A systematic review and meta-analysis by Ardern et al in 2014 investigating return to sport outcomes in athletes after ACL Reconstruction found that 81% of athletes returned to any sport, 65% returned to their preinjury level of sport, and 55% returned to their competitive level of sport.
Similarly, another study identified an ACLRSI score 60 at six months being predictive of returning to running and to pre-injury sport level at a two-year follow-up. An ACL-RSI score of 65/100 was deemed optimal for returning to the same sport at a two-year follow-up [51].
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The Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale was created to evaluate psychological readiness with regard to Return-to-Sport and has identified psychological aspects for which patients may need counseling, concurrent with the physical rehabilitation, to increase their chances of a
The ACL-RSI scores range from 0 to 100, with higher scores representing patients who are more ready to return to sport. An ACL-RSI score of 56 or less has correctly identified adult athletes who may fail to return to their sport after surgery due to psychological factors.

acl rsi score pdf