Key facts
- Score direction
- Higher is better
- Meaningful change
- For the 12-item form, a 13.4-point minimal important change has been reported between 6 and 12 months after primary anterior cruciate ligament reconstruction, while the individual smallest detectable change was 26.6 points. These estimates are population and time specific. A single cut-off must not be used as the sole return-to-sport clearance criterion.
- Scoring
- The standard ACL-RSI contains 12 items scored from 0 to 100. Negative items use anchors that place the most negative response at 0 and the most positive response at 100, so no additional reverse coding is required. The t…
- Time to complete
- 3 min
- Licensing
- Licensed instrument - check copyright terms before clinical use
About the ACL Return to Sport after Injury Scale (ACL-RSI)
The ACL-RSI measures an athlete's psychological response to returning to sport after an anterior cruciate ligament injury or reconstruction. It covers emotions, confidence in performance and appraisal of reinjury risk. Tracking the score during rehabilitation can identify concerns that may benefit from discussion or targeted support, but the measure must be combined with clinical assessment and physical performance testing.
Medical Specialties
Anatomic Areas
Clinical Indications
Developer Information
Developed by Kate E. Webster, Julian A. Feller and Christina Lambros and published in 2008. Preliminary validation in 220 people after ACL reconstruction reported high internal consistency and lower scores among those who had stopped sport. A validated six-item short form was published in 2018, but this implementation uses the standard 12-item version.
Copyright & Licensing
The ACL-RSI is the intellectual work of Webster, Feller and Lambros. Authoritative commercial reuse rights were not identified. Obtain written permission or rights confirmation before production publication, commercial electronic administration, translation or adaptation, and cite the 2008 development paper.
Administration Instructions
Please answer the following questions referring to your main sport prior to injury. For each question, select a position between the two descriptions to indicate how you feel right now relative to the two extremes.
Scoring Methodology
The standard ACL-RSI contains 12 items scored from 0 to 100. Negative items use anchors that place the most negative response at 0 and the most positive response at 100, so no additional reverse coding is required. The total is the arithmetic mean of all 12 item values and ranges from 0 to 100. All 12 items are required. Higher scores indicate greater psychological readiness to return to sport.
Meaningful Change Threshold
For the 12-item form, a 13.4-point minimal important change has been reported between 6 and 12 months after primary anterior cruciate ligament reconstruction, while the individual smallest detectable change was 26.6 points. These estimates are population and time specific. A single cut-off must not be used as the sole return-to-sport clearance criterion.
Score Interpretation
Understanding what your score means
lower six month score
0 - 41.9At six months after primary reconstruction, scores below 42 have been associated with not returning to pre-injury sport by 12 months. This is a contextual screening threshold, not a clearance rule.
uncertain six month range
42 - 61.9Six-month predictive implications are uncertain in this range and require clinical context.
higher six month score
62 - 100At six months after primary reconstruction, scores of 62 or more have been associated with return to pre-injury sport by 12 months. This does not establish physical readiness or safe clearance.
Subscales
This questionnaire measures multiple dimensions
Emotions(0-100)
Nervousness, frustration, fear, concern about accidental injury and relaxation.
Confidence in Performance(0-100)
Confidence in previous-level performance, knee stability, playing without concern, pressure tolerance and sporting performance.
Risk Appraisal(0-100)
Perceived reinjury likelihood and the effect of thoughts about repeat surgery and rehabilitation.
Clinical Limitations & Considerations
The scale assesses psychological readiness only and must not be used alone to clear return to sport. Scores vary with rehabilitation stage, sport, age and previous experience. Proposed thresholds differ across cohorts and do not consistently predict reinjury. This implementation is the 12-item standard version and should not be compared interchangeably with a six-item score unless the version is documented.
Supporting Literature
Key validation and development studies for the ACL Return to Sport after Injury Scale (ACL-RSI)
- 1
Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery
Webster KE, Feller JA, Lambros C
Physical Therapy in Sport, 2008
- 2
Development and validation of a short version of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale
Webster KE, Feller JA
Orthopaedic Journal of Sports Medicine, 2018
Frequently asked questions
What does a lower six month score ACL Return to Sport after Injury Scale (ACL-RSI) score mean?
A ACL Return to Sport after Injury Scale (ACL-RSI) score of 0 to 41.9 is classified as lower six month score. At six months after primary reconstruction, scores below 42 have been associated with not returning to pre-injury sport by 12 months. This is a contextual screening threshold, not a clearance rule.
What does a higher six month score ACL Return to Sport after Injury Scale (ACL-RSI) score mean?
A ACL Return to Sport after Injury Scale (ACL-RSI) score of 62 to 100 is classified as higher six month score. At six months after primary reconstruction, scores of 62 or more have been associated with return to pre-injury sport by 12 months. This does not establish physical readiness or safe clearance.
What does a uncertain six month range ACL Return to Sport after Injury Scale (ACL-RSI) score mean?
A ACL Return to Sport after Injury Scale (ACL-RSI) score of 42 to 61.9 is classified as uncertain six month range. Six-month predictive implications are uncertain in this range and require clinical context.
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