Background Psychological readiness to return to sport and subjective knee function are critical outcomes following ACL reconstruction (ACLR), yet they do not always progress in parallel. An athlete may demonstrate high subjective knee function but low psychological readiness, suggesting a mental barrier to return, or conversely, report high readiness despite persistent functional limitations, raising concerns of overconfidence and reinjury risk. Understanding how these domains change together during recovery is essential for identifying mismatches that may require targeted intervention.

Purpose The purpose of this study is to examine the relationship between changes in psychological readiness (ACL-RSI) and subjective knee function (IKDC) from early to late recovery following ACLR.

Study Design Secondary analysis of prospectively collected data.

Methods Athletes (N = 48, Age at ACLR = 17.7 ± 1.8 y) aged 15-25 years who underwent ACLR with an ipsilateral autograft, had a pre-injury MARX score > 8, and completed the ACL-RSI and IKDC questionnaires at 3.5 ± 1 and 7 ± 1 months post-ACLR were included. Percent changes in ACL-RSI and IKDC scores between early and late recovery were calculated. Spearman’s rank correlation was used to examine the association between changes in psychological readiness and subjective knee function. Significance was set to p < .05.

Results The mean percent change in ACL-RSI was 40.7 ± 57.1% and the mean percent change in IKDC was 24.8 ± 18.1% from 3.5 ± 1 months to 7 ± 1 months post-ACLR. The percent changes in ACL-RSI and IKDC scores from 3.5 ± 1 months to 7 ± 1 months post-ACLR were moderately correlated (ρ = 0.350 (95% CI [0.089, 0.584]), p = 0.012).

Discussion The main finding of this study was that subjective knee function and psychological readiness to return to sport changed in parallel from 3.5 to 7 months following ACLR. Clinicians can use this information regarding the concordant progression of psychological readiness to return to sport and subjective knee function to personalize ACL rehabilitation for future patients. Overall, clinicians can understand that if psychological readiness improves, subjective knee function will likely improve over the 3.5- to 7-month post-ACLR time frame, and vice versa. Therefore, focusing on both of these components at multiple time points during the recovery process may be influential to ensure the greatest likelihood of returning to sport in athletes following ACLR.

The authors have declared no competing interest.

This study did not receive any funding.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Sanford Health Institutional Review Board granted this study an exemption (Study ID: 2390).

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Conflict of Interest: The authors report no conflicts of interest.

Ethical Statement: The Sanford Health Institutional Review Board granted this study an exemption (Study ID: 2390).

Funding: This study did not receive any funding.

Data produced in the present study are available upon reasonable request to the authors.