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Return to preinjury sports after anterior cruciate ligament reconstruction is predicted by five independent factors

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To determine factors that predict return to the same frequency and type of sports participation with similar activity demands as before injury.

Methods

Individuals 1 to 5 years after primary ACL reconstruction completed a comprehensive survey related to sports participation and activity before injury and after surgery. Patient characteristics, injury variables, and surgical variables were extracted from the medical record. Return to preinjury sports (RTPS) was defined as: “Returning to the same or more demanding type of sports participation, at the same or greater frequency with the same or better Marx Activity Score as before injury.” Variables were compared between individuals that achieved comprehensive RTPS and those that did not with univariate and multivariate logistic regression models.

Results

Two-hundred and fifty-one patients (mean age 26.1 years, SD 9.9) completed the survey at an average of 3.4 years (SD 1.3) after ACL reconstruction. The overall rate of RTPS was 48.6%. Patients were more likely to RTPS if they were younger than 19 years old (OR = 4.07; 95%CI 2.21–7.50; p < 0.01) or if they were competitive athletes (OR = 2.07; 95%CI 1.24–3.46; p = 0.01). Patients were less likely to RTPS if surgery occurred more than 3 months after injury (OR = 0.31, 95%CI 0.17–0.58; p < 0.01), if there was a concomitant cartilage lesion (OR = 0.38; 95%CI 0.21–0.70; p < 0.01), and if cartilage surgery was performed (OR = 0.17; 95%CI 0.04–0.80; p = 0.02).

Conclusion

Five variables best predicted RTPS including age at time of surgery. Only time from injury to surgery is a potentially modifiable factor to improve RTPS; however, the reasons for which patients delayed surgery may also contribute to them not returning to sports. Regardless, younger patients, those that partake in sports on a competitive level, those that undergo surgery sooner, or do not have a cartilage injury or require cartilage surgery are more likely to return to pre-injury sports participation.

Level of evidence

III.

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No funding was received from any entity in support of this study or manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Xpert Clinics, Laarderhoogtweg 12, 1101 EA, Amsterdam, The Netherlands

    Bart Muller & C. Niek van Dijk

  2. Department of Rehabilitation Sciences, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan

    Mohammad A. Yabroudi

  3. Department of Physical Therapy, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA

    Andrew Lynch, Adam J. Popchak & James J. Irrgang

  4. Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare, 199, sec. 1, San-Min Road, Taichung, Taiwan

    Chung-Liang Lai

  5. Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA

    Freddie H. Fu & James J. Irrgang

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  1. Bart Muller
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Correspondence to James J. Irrgang.

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The study received ethical approval before commencement by the Institutional Review Board at the University of Pittsburgh (protocol number PRO11120006). All subjects provided written informed consent for participation in this study.

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Muller, B., Yabroudi, M.A., Lynch, A. et al. Return to preinjury sports after anterior cruciate ligament reconstruction is predicted by five independent factors. Knee Surg Sports Traumatol Arthrosc 30, 84–92 (2022). https://doi.org/10.1007/s00167-021-06558-z

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