Psychological readiness to return-to-sport after anterior cruciate ligament reconstruction can be influenced by sex difference and functional assessment

The primary aim was to evaluate the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scores before- and after-functional assessment in male and female Anterior Cruciate Ligament (ACL) reconstructed patients at a 9-month follow-up. (1st and 2nd ACL-RSI score, respectively). This study included 201 patients (Sex, 119 males and 82 females; Age, 27.0 ± 9.1 yrs.) who underwent primary isolated ACL reconstruction and performed a functional assessment at a 9-month follow-up appointment. Clinical measurements include: anthropometric measurement, patient-reported outcome measures, knee laxity assessment, knee muscle strength, and functional tasks. The ACL-RSI questionnaire was administered before and after the functional assessment. Statistical models were used to detect statistical differences and correlations between variables. The 2nd ACL-RSI score was significantly higher than 1st ACL-RSI score in both the male and female groups (p < 0.001). The 2nd ACL-RSI score was higher in the males than females (p = 0.035). In the female group, ACL-RSI change was significantly negatively correlated with hop for distance (r = −0.255, p = 0.021) and hop for height (r = −0.259, p = 0.019). ACL-RSI score was significantly improved after the functional assessment in both males and females. Compared to the female group, the 2nd ACL-RSI score was significantly higher in the male group. The change in ACL-RSI scores from pre-to post-functional test was negatively correlated with functional performance in the female group but not with the male group. Clinicians should consider sex difference as well as change in psychological readiness between pre- and post-functional assessment of their patients to inform safe return of sport. Sex differences and repeated assessment should be considered for postoperative evaluation of psychological readiness for return to sport because ACL-RSI was determined to be sensitive to these factors.