Translation, cross-cultural adaptation, validation, and measurement properties of the Spanish version of the anterior cruciate ligament-return to sport after injury (ACL-RSI-Sp) scale

  • Esther Sala-Barat
  • Pedro Álvarez-DíazEmail author
  • Eduard Alentorn-Geli
  • Kate E. Webster
  • Ramón Cugat
  • Joaquín Tomás-Sabado



To translate into Spanish and validate the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale, and to evaluate the psychological factors that have the greatest impact on the return to play among Spanish football players.


The ACL-RSI was first translated into Spanish by two teams of bilingual experts. At the time of discharge, 114 amateur and semi-professional football players who underwent ACL reconstruction answered a questionnaire regarding demographic and injury-related data, along with the translated ACL-RSI, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Tampa Scale for Kinesiophobia (TSK-11SV) and the injury-psychological readiness to return to sport (I-PRRS). Statistical analysis included reliability tests (Cronbach’s alpha and test–retest), construct validity and exploratory factor analysis.


The ACL-RSI-Sp showed excellent internal consistency (Cronbach’s α = 0.9), temporal stability (test–retest r = 0.9) and significant moderate correlations with the KOOS subscales of symptoms (r = 0.4; p < 0.01), pain (r = 0.4; p < 0.01), daily life (r = 0.4; p < 0.01), “sport” (r = 0.5; p < 0.01) and quality of life (r = 0.6; p < 0.01). Significant moderate and strong correlations were also observed for the ACL-RSI-Sp with the TSK (r = − 0.5; p < 0.01) and the I-PRRS (r = 0.8; p < 0.01), respectively. Confidence in performance (1) and fear and insecurity (2) explained 62.6% of the total variance in ACL-RSI-Sp.


The ACL-RSI-Sp was a valid and reliable instrument to evaluate the relevant psychological factors in the return to sports of Spanish football players after ACL reconstruction. Players’ confidence in performance and fear and insecurity were the most important factors influencing the return to play in this population.

Level of evidence

Level IV.


ACL reconstruction Psychological factors Return to sport Patient-reported measures 


Author contributions

ES, PAD, and JTS: have made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data. ES, PAD, EAG, KEW, RC, and JTS: have been involved in drafting the manuscript or revising it critically for important intellectual content. ES, PAD, EAG, KEW, RC, and JTS: have given final approval of the version to be published. ES, PAD, EAG, KEW, RC, and JTS: agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


No funding was received for the present study.

Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interest for the present study.

Ethical approval

This study has been conducted in accordance with the ethical standards at our Institution and with the 1964 Helsinki Declaration and its later amendments.


  1. 1.
    Ardern CL, Osterberg A, Tagesson S, Gauffin H, Webster KE et al (2014) The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. Br J Sports Med 48:1613–1619CrossRefPubMedGoogle Scholar
  2. 2.
    Beaton DE, Bombardier C, Guillemin F, Ferraz MB (2000) Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976) 25:3186–3191CrossRefGoogle Scholar
  3. 3.
    Bohu Y, Klouche S, Lefevre N, Webster K, Herman S (2015) Translation, cross-cultural adaptation and validation of the French version of the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale. Knee Surg Sports Traumatol Arthrosc 23:1192–1196CrossRefPubMedGoogle Scholar
  4. 4.
    Cattell RB (1966) The scree test for the number of factors. Multivar Behav Res 1:245–276CrossRefGoogle Scholar
  5. 5.
    Chen T, Zhang P, Li Y, Webster K, Zhang J et al (2017) Translation, cultural adaptation and validation of simplified Chinese version of the anterior cruciate ligament return to sport after injury (ACL-RSI) scale. PLoS One 12:e0183095CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Fältström A, Hägglund M, Kvist J (2016) Factors associated with playing football after anterior cruciate ligament reconstruction in female football players. Scand J Med Sci Sports 26:1343–1352CrossRefPubMedGoogle Scholar
  7. 7.
    Glazer DD (2009) Development and preliminary validation of the injury-psychological readiness to return to sport (I-PRRS) scale. J Athl Train 44:185–189CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Gómez P, Sainz de Baranda P, Ortega E, Contreras O, Olmedilla A (2014) Diseño y validación de un cuestionario sobre la percepción del deportista respecto a su reincorporación al entrenamiento (Design and validation of a questionnaire about the perception of the athlete regarding their re-entry into training). Revista de Psicología del Deporte 23:479–487 (Spanish) Google Scholar
  9. 9.
    Gómez-Pérez L, López-Martínez AE, Ruiz-Párraga GT (2011) Psychometric properties of the spanish version of the tampa scale for kinesiophobia (TSK). J Pain 12:425–435CrossRefPubMedGoogle Scholar
  10. 10.
    Harput G, Tok D, Ulusoy B, Eraslan L, Yildiz TI et al (2017) Translation and cross-cultural adaptation of the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale into Turkish. Knee Surg Sports Traumatol Arthrosc 25:159–164CrossRefPubMedGoogle Scholar
  11. 11.
    Herring SA, Kibler WB, Putukian M (2012) The team physician and the return-to-play decision: a consensus statement-2012 update. Med Sci Sports Exerc 44:2446–2448CrossRefPubMedGoogle Scholar
  12. 12.
    Corp IBM (2016) IBM SPSS Statistics for Windows, Version 24.0. IBM Corp, ArmonkGoogle Scholar
  13. 13.
    Kaiser HF (1960) The application of electronic computers to factor analysis. Educ Psychol Meas 20:141–151CrossRefGoogle Scholar
  14. 14.
    Kori SH, Miller RP, Todd DD (1990) Kinesiophobia: a new view of chronic pain behavior. Pain Manag 3:35–43Google Scholar
  15. 15.
    Kvist J, Österberg A, Gauffin H, Tagesson S, Webster K et al (2013) Translation and measurement properties of the Swedish version of ACL-Return to sports after injury questionnaire. Scand J Med Sci Sports 23:568–575PubMedGoogle Scholar
  16. 16.
    Lai CCH, Ardern CL, Feller JA, Webster KE (2018) Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes. Br J Sports Med 52:128–138CrossRefPubMedGoogle Scholar
  17. 17.
    Lynch AD, Logerstedt DS, Grindem H, Eitzen I, Hicks GE et al (2015) Consensus criteria for defining ‘successful outcome’ after ACL injury and reconstruction: a Delaware–Oslo ACL cohort investigation. Br J Sports Med 49:335–342CrossRefPubMedGoogle Scholar
  18. 18.
    McHorney CA, Tarlov AR (1995) Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res 4:293–307CrossRefPubMedGoogle Scholar
  19. 19.
    Meeuwisse WH, Tyreman H, Hagel B, Emery C (2007) A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Clin J Sport Med 17:215–219CrossRefPubMedGoogle Scholar
  20. 20.
    Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee injury and osteoarthritis outcome score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96CrossRefPubMedGoogle Scholar
  21. 21.
    Slagers AJ, Reininga IH, van den Akker-Scheek I (2017) The Dutch language anterior cruciate ligament return to sport after injury scale (ACL-RSI)—validity and reliability. J Sports Sci 35:393–401CrossRefPubMedGoogle Scholar
  22. 22.
    Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL et al (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42CrossRefPubMedGoogle Scholar
  23. 23.
    Vaquero J, Longo UG, Forriol F, Martinelli N, Vethencourt R et al (2014) Reliability, validity and responsiveness of the Spanish version of the knee injury and osteoarthritis outcome score (KOOS) in patients with chondral lesion of the knee. Knee Surg Sports Traumatol Arthrosc 22:104–108CrossRefPubMedGoogle Scholar
  24. 24.
    Webster KE, Feller JA, Lambros C (2008) Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport 9:9–15CrossRefPubMedGoogle Scholar
  25. 25.
    Webster KE, Feller JA, Whitehead TS (2017) Return to sport following ACL reconstruction: the Australian Experience. In: Musahl V, Karlsson J, Kuroda R, Zaffagnini S (eds) Rotatory knee instability. Springer International Publishing, Basel, pp 413–425CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Esther Sala-Barat
    • 1
    • 2
  • Pedro Álvarez-Díaz
    • 2
    • 3
    • 4
    • 5
    Email author
  • Eduard Alentorn-Geli
    • 2
    • 3
    • 4
  • Kate E. Webster
    • 6
  • Ramón Cugat
    • 2
    • 3
    • 4
  • Joaquín Tomás-Sabado
    • 1
  1. 1.Escuelas Universitarias GimbernatUniversidad Autonoma de BarcelonaBarcelonaSpain
  2. 2.Mutualidad Catalana de Futbolistas, Federación Española de FutbolBarcelonaSpain
  3. 3.Fundación García-CugatBarcelonaSpain
  4. 4.Artroscopia gc, SLBarcelonaSpain
  5. 5.Universidad Internacional de CataluñaBarcelonaSpain
  6. 6.School of Allied-HealthLa Trobe UniversityMelbourneAustralia

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