Sports Health A Multidisciplinary Approach · IF 2.7 · September 11, 2026 · LoE III
Functional and Psychological Predictors of Return to Sport and Reinjury Risk in Professional Athletes After ACL Reconstruction
Mohammad Rahimi Khoygani, Hamed Esmaili — University of Rome Tor Vergata
This mixed prospective-retrospective cohort followed 127 professional athletes after ACL reconstruction, comparing 32 who suffered a noncontact graft rupture within 3 years against matched non-reinjured controls using 10 functional hop tests, limb symmetry index (LSI), and patient-reported outcome measures. Absolute hop performance (distance/time) differed significantly between reinjured and non-reinjured athletes on most tests (e.g., lateral hop for distance in males: 104.7 vs 160.0 cm, P<0.001), while LSI showed a significant difference in only one test (TCHD in females, P=0.03). The ACL-RSI psychological readiness score correlated moderately-to-strongly with hop performance (r=0.43-0.73) in both groups, whereas KOOS and IKDC did not correlate with hop tests.
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersThis challenges the common reliance on limb symmetry index for return-to-sport clearance, suggesting absolute performance benchmarks and psychological readiness scores may better flag athletes at risk of ACL graft reinjury.
Conclusion strengthPotentially practice-changing
This identifies a risk factor rather than testing a treatment, so it cannot support a change in what we do.
Presenting this at rounds? Start here
- ?If LSI can mask meaningful deficits, how should surgeons and rehab teams change their return-to-sport clearance criteria for elite pivoting-sport athletes?
- ?Should ACL-RSI screening be incorporated routinely before high-demand functional testing, and how would a low score change the timing or sequence of an athlete's rehabilitation?