Introduction Return-to-sport testing after anterior cruciate ligament (ACL) reconstruction traditionally occurs during pre-planned activities. The aim of this study was to investigate the relationships between a novel multidirectional reactive agility test, functional performance and patient-reported outcome measures in athletes after ACL reconstruction.

Materials and methods Twenty-eight ACL-reconstructed athletes (24 males, 4 females; 24.6±4.4 years; 6 months postoperative), participated in the study. All athletes underwent an evaluation including a novel multidirectional reactive agility test (tested with Smartgoals, a light-based reactive training system to measure the time to complete a task), functional performance tests: 1) two hop tests (single-leg hop for distance, triple hop for distance), 2) the Y-balance test conducted with eyes closed and patient-reported outcome measures (ACL-Return to Sports after Injury (ACL-RSI) scale, Knee Self-Efficacy Scale (K-SES), International Knee Documentation Committee (IKDC) subjective knee form). Spearman correlation coefficients were calculated between the outcomes on the multidirectional reactive agility test, and the functional performance and patient-reported outcome measures.

Results The time to complete the multidirectional reactive agility test was significantly (p<0.05) negatively correlated with absolute hop test distances (r=−0.52 to −0.53), hop tests limb symmetry indices (r=−0.41 to −0.49), posteromedial (r=−0.64) and posterolateral (r=−0.61) reach distances on the Y-balance test, and K-SES future (r=−0.39), ACL-RSI (r=−0.39) and IKDC scores (r=−0.44).

Conclusion Faster reactive agility was significantly correlated with better functional performance and patient-reported outcome measures. These results suggest to consider implementing multidirectional reactive agility testing within the continuum of the return-to-sport decision-making process in athletes after ACL reconstruction.