Translation, cross-cultural adaptation, and validation of the Italian version of the anterior cruciate ligament–return to sport after injury (ACL-RSI) scale and its integration into the K-STARTS test

Background: The timing of a return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) represents a major subject of debate in sports medicine practice. Recently, the Knee Santy Athletic Return to Sport (K‐STARTS) composite test was validated. This consists of a battery of physical tests and a psychological evaluation using the anterior cruciate ligament–return to sport after injury scale (ACL‐RSI). This study aimed to translate the ACL‐RSI and K‐STARTS from English to Italian and determine the scale’s reliability and validity in an Italian context. Methods: The translation and cultural adaptation process was performed according to the guidelines for the cross‐ cultural adaptation of self‐report measures. The patients were asked to fill an anonymized online form created for this purpose that included the KOOS, the Lysholm, the IKDC‐SKF, and the Italian translation of the ACL‐RSI (ACL‐RSI‐It). After 1 week, the attendees were asked to repeat the ACL‐RSI‐It to investigate the test–retest reliability. Results: The final study population comprised 115 patients who underwent ACLR, with a mean follow‐up of 37.37 ± 26.56 months. The ACL‐RSI‐It showed axcellent internal consistency (Cronbach’s α = 0.963), reliability (test– retest ICC = 0.966), and good construct validity (positive correlations with the other scales were above 75%). Conclusions: The ACL‐RSI‐It is valid, reliable, and comparable to the original English version of the questionnaire for Italian‐speaking patients. It can be used to assess the psychological readiness of patients for a RTS after primary and unilateral ACLR, and can be integrated into the Italian K‐STARTS test.