ACL-RSI

For Medical Students

What It Tests

The ACL-RSI asks about a patient's confidence, their appraisal of risk and their emotion around returning to sport after a cruciate injury. 4.21.8 covers return to play decision making.

It measures psychological readiness, which is a separate component of return to sport from strength and control. 4.21.7 covers return to sport testing.

It matters because confidence limits return independently of physical capacity, and the functional battery does not detect that. 4.21.2 covers the single leg hop.

How It Is Performed

Give it to the patient to complete themselves, which matters more here than for a symptom score because the subject is their own state of mind.

Give it away from the clinician, since confidence reported to a surgeon is not the same as confidence reported privately.

Explain that there is no right answer, because patients otherwise report what they think is expected.

Check completeness before scoring. 4.1.8 covers examination documentation.

Score it with the published method.

Record it alongside the functional battery rather than instead of any part of it. 4.21.7 covers return to sport testing.

Repeat it, because confidence changes through rehabilitation. 4.2.34 covers previous rehabilitation.

What a Positive Means

A score is read as the patient's current psychological readiness, alongside the physical results.

A low score with passing physical tests identifies confidence as the limiting factor, which has its own intervention. 4.21.7 covers return to sport testing.

A high score with failing physical tests identifies an athlete who may return before they are physically ready. 4.21.8 covers return to play decision making.

A score that does not improve through rehabilitation is a finding rather than a personality. 4.2.34 covers previous rehabilitation.

An incomplete questionnaire is unscored.

No item count, score range or validation figure appears on this page. Those are properties of a published instrument and stating one from memory is the same class of claim as an invented citation, so the page describes what the instrument does and a reviewer with the questionnaire can add the numbers.

MRCS Level

How It Is Performed

In a viva this is the instrument to name when asked what the physical tests miss.

The expected points are the private self completion, the absence of a right answer, the completeness, the published scoring, the pairing with the battery and the repetition through rehabilitation.

Say that it measures psychological readiness and name it as a separate component. 4.21.7 covers return to sport testing.

Say that you would repeat it rather than measure it once. 4.2.34 covers previous rehabilitation.

Say that it is recorded alongside the physical tests. 4.21.8 covers return to play decision making.

What a Positive Means

The reasoning expected is that returning to sport requires the athlete to load the knee in the way that injured it, which is a decision as much as a capacity. 4.21.8 covers return to play decision making.

Fear of reinjury changes movement as well as willingness, so it affects the physical tests too and is not separable from them by those tests. 4.21.4 covers the crossover hop.

Confidence recovers on a different timescale from strength, which is why the two are measured separately. 4.21.7 covers return to sport testing.

A psychological measure predicts actual return in the literature, which is why it is in the battery rather than beside it. 4.22.8 covers the use of these scores.

How Good It Is

The instrument is reproducible and measures something no other part of the assessment reaches.

Its best contribution is identifying the athlete whose limitation is confidence, because that limitation is addressable and would otherwise be read as weakness. 4.21.2 covers the single leg hop.

It depends entirely on self report, with the usual consequences.

No examination finding and no imaging corresponds to it. 4.1.6 covers that relationship.

No figures appear for any accuracy comparison on this page, under decision 023, and the comparison is the claim being made.

No item count, score range or validation figure appears on this page. Those are properties of a published instrument and stating one from memory is the same class of claim as an invented citation, so the page describes what the instrument does and a reviewer with the questionnaire can add the numbers.

FRCS Level

How Good It Is

At decision level this instrument supplies the component of readiness the rest of the assessment cannot see.

A low score identifies a target for intervention rather than a reason to refuse return, and the distinction matters to the conversation. 4.21.8 covers return to play decision making.

A high score with physical deficits identifies the athlete most likely to return early against advice, which changes how the advice is given. 4.21.7 covers return to sport testing.

A serial record shows whether rehabilitation is changing confidence as well as strength. 4.2.34 covers previous rehabilitation.

Its omission leaves a battery that measures the knee and not the athlete. 4.22.8 covers the use of these scores.

Where It Misleads

The commonest error is omitting it, which leaves confidence inferred from behaviour. 4.21.7 covers return to sport testing.

It is completed in front of the clinician, which changes the answers.

A low score is read as a reason to refuse return rather than as a target. 4.21.8 covers return to play decision making.

It is measured once, so a changing quantity is treated as fixed. 4.2.34 covers previous rehabilitation.

A high score is read as readiness on its own, without the physical tests. 4.21.2 covers the single leg hop.

Fellowship Level

Where It Misleads

At fellowship level this instrument raises a question the rest of the battery does not, which is what to do with a psychological finding.

Confidence is modifiable, so a score is a snapshot of an intervention target rather than a trait, and treating it as fixed misuses it. 4.2.34 covers previous rehabilitation.

Fear and capacity are entangled, since fear alters movement and altered movement alters the physical scores, so the separation the battery assumes is incomplete. 4.21.4 covers the crossover hop.

A score completed for a clinician who will decide about return is subject to an obvious incentive, and the instrument has no defence against it. 4.22.8 covers the use of these scores.

Its relationship to actual return and to reinjury is a literature question with quantities this repository does not state. 4.21.8 covers return to play decision making.

Acting on a psychological finding requires resources a knee clinic may not have, which turns a measurement into a referral question. 4.21.7 covers return to sport testing.

No item count, score range or validation figure appears on this page. Those are properties of a published instrument and stating one from memory is the same class of claim as an invented citation, so the page describes what the instrument does and a reviewer with the questionnaire can add the numbers.