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The majority of athletes fail to return to play following anterior cruciate ligament reconstruction due to reasons other than the operated knee

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study is to evaluate the reasons why athletes do not return to play (RTP) following anterior cruciate ligament (ACL) reconstruction from a large single-centre database.

Methods

The institutional ACL registry was screened for patients that had undergone a primary ACLR and had RTP status reported at 24-month follow-up. The reasons that patients were unable to RTP at 24 months were evaluated. The ACL-Return to Sport Index (ACL-RSI) was evaluated at baseline and 24-month follow-up to evaluate psychological ability to RTP.

Results

At 2 years, 1140 patients returned to play, and 222 had not returned to play. The most common reasons athletes were unable to return was fear of reinjury (27.5%), lack of confidence in performance on return (19.4%) and external life factors (16.6%), i.e. work commitments and family reasons. Other reasons for athletes not returning to play were residual knee pain (10%) and subsequent injury (5%). The ACL-RSI score was significantly lower at diagnosis (40.3 vs. 49.3; p = 0.003) and 2 years (41.8 vs. 78.7; p < 0.0001) in athletes who did not return to play vs. those that did RTP.

Conclusion

The majority of patients that report they have not returned to play do so due to external life and psychological factors associated with their injury, including fear of reinjury and lack of confidence in performance. A small minority of patients were unable to return due to residual knee symptoms or reinjury. Pre-operative psychological assessment and intervention may identify those less likely to RTP and provide an opportunity for targeted interventions to further improve RTP outcomes.

Level of evidence

III.

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References

  1. Ardern CL, Taylor NF, Feller JA, Webster KE (2012) Fear of re-injury in people who have returned to sport following anterior cruciate ligament reconstruction surgery. J Sci Med Sport 15:488–495

    Article  Google Scholar 

  2. Ardern CL, Taylor NF, Feller JA, Webster KE (2014) Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 48:1543–1552

    Article  Google Scholar 

  3. Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med 39:538–543

    Article  Google Scholar 

  4. Barry M, Thomas R, Rees A, Shafighian B, Mowbray MAS (1995) Effect of ACL reconstruction on meniscal and chondral lesions in the chronic anterior cruciate deficient knee. Knee 2:201–205

    Article  Google Scholar 

  5. Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE (2005) Treatment of anterior cruciate ligament injuries, part I. Am J Sports Med 33:1579–1602

    Article  Google Scholar 

  6. Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE (2005) Treatment of anterior cruciate ligament injuries, part 2. Am J Sports Med 33:1751–1767

    Article  Google Scholar 

  7. Brewer BW (2010) The role of psychological factors in sport injury rehabilitation outcomes. Int Rev Sport Exerc Psychol 3:40–61

    Article  Google Scholar 

  8. Cascio BM, Culp L, Cosgarea AJ (2004) Return to play after anterior cruciate ligament reconstruction. Clin Sports Med 23:395–408

    Article  Google Scholar 

  9. Cupal DD, Brewer BW (2001) Effects of relaxation and guided imagery on knee strength, reinjury anxiety, and pain following anterior cruciate ligament reconstruction. Rehabil Psychol 46:28

    Article  Google Scholar 

  10. Dingenen B, Gokeler A (2017) Optimization of the return-to-sport paradigm after anterior cruciate ligament reconstruction: a critical step back to move forward. Sports Med 47:1487–1500

    Article  Google Scholar 

  11. Dunn WR, Spindler KP, Consortium M (2010) Predictors of activity level 2 years after anterior cruciate ligament reconstruction (ACLR): a multicenter orthopaedic outcomes network (MOON) ACLR cohort study. Am J Sports Med 38:2040–2050

    Article  Google Scholar 

  12. Finsterbush A, Frankl U, Matan Y, Mann G (1990) Secondary damage to the knee after isolated injury of the anterior cruciate ligament. Am J Sports Med 18:475–479

    Article  CAS  Google Scholar 

  13. Forsdyke D, Smith A, Jones M, Gledhill A (2016) Psychosocial factors associated with outcomes of sports injury rehabilitation in competitive athletes: a mixed studies systematic review. Br J Sports Med 50:537–544

    Article  Google Scholar 

  14. Hagino T, Ochiai S, Senga S, Yamashita T, Wako M, Ando T et al (2015) Meniscal tears associated with anterior cruciate ligament injury. Arch Orthop Trauma Surg 135:1701–1706

    Article  Google Scholar 

  15. Ivarsson A, Tranaeus U, Johnson U, Stenling A (2017) Negative psychological responses of injury and rehabilitation adherence effects on return to play in competitive athletes: a systematic review and meta-analysis. Open Access J Sports Med 8:27–32

    Article  Google Scholar 

  16. Kvist J, Ek A, Sporrstedt K, Good L (2005) Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 13:393–397

    Article  Google Scholar 

  17. Kvist J (2004) Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation. Sports Med 34:269–280

    Article  Google Scholar 

  18. Lee DY, Karim SA, Chang HC (2008) Return to sports after anterior cruciate ligament reconstruction - a review of patients with minimum 5-year follow-up. Ann Acad Med Singapore 37:273–278

    PubMed  Google Scholar 

  19. Lynch AD, Logerstedt DS, Grindem H, Eitzen I, Hicks GE, Axe MJ et al (2015) Consensus criteria for defining 'successful outcome’ after ACL injury and reconstruction: a Delaware-Oslo ACL cohort investigation. Br J Sports Med 49:335–342

    Article  Google Scholar 

  20. Maddison R, Prapavessis H, Clatworthy M (2006) Modeling and rehabilitation following anterior cruciate ligament reconstruction. Ann Behav Med 31:89–98

    Article  Google Scholar 

  21. Meierbachtol A, Obermeier M, Yungtum W, Bottoms J, Paur E, Nelson BJ et al (2020) Injury-related fears during the return-to-sport phase of ACL reconstruction rehabilitation. Orthop J Sports Med 8:2325967120909385

    Article  Google Scholar 

  22. Park S, Lavallee D, Tod D (2013) Athletes’ career transition out of sport: a systematic review. Internat Rev Sport Exerc Psychol 6:22–53

    Article  Google Scholar 

  23. Podlog L, Eklund RC (2006) A longitudinal investigation of competitive athletes’ return to sport following serious injury. J Appl Sport Psychol 18:44–68

    Article  Google Scholar 

  24. Podlog L, Eklund RC (2007) The psychosocial aspects of a return to sport following serious injury: a review of the literature from a self-determination perspective. Psychol Sport Exerc 8:535–536

    Article  Google Scholar 

  25. Podlog L, Heil J, Schulte S (2014) Psychosocial factors in sports injury rehabilitation and return to play. Phys Med Rehabil Clin N Am 25:915–930

    Article  Google Scholar 

  26. Rodriguez RM, Marroquin A, Cosby N (2019) Reducing fear of reinjury and pain perception in athletes with first-time anterior cruciate ligament reconstructions by implementing imagery training. J Sport Rehabil 28:385–389

    Article  Google Scholar 

  27. Ross BJ, Savage-Elliott I, Brown SM, Mulcahey MK (2020) Return to play and performance after primary ACL reconstruction in American football players: a systematic review. Orthop J Sports Med 8:2325967120959654

    Article  Google Scholar 

  28. Snoeker BA, Roemer FW, Turkiewicz A, Lohmander S, Frobell RB, Englund M (2020) Does early anterior cruciate ligament reconstruction prevent development of meniscal damage? Results from a secondary analysis of a randomised controlled trial. Br J Sports Med 54:612–617

    Article  Google Scholar 

  29. Swirtun LR, Eriksson K, Renstrom P (2006) Who chooses anterior cruciate ligament reconstruction and why? A 2-year prospective study. Scand J Med Sci Sports 16:441–446

    Article  CAS  Google Scholar 

  30. Tjong VK, Murnaghan ML, Nyhof-Young JM, Ogilvie-Harris DJ (2014) A qualitative investigation of the decision to return to sport after anterior cruciate ligament reconstruction: to play or not to play. Am J Sports Med 42:336–342

    Article  Google Scholar 

  31. Tripp DA, Stanish W, Ebel-Lam A, Brewer BW, Birchard J (2007) Fear of reinjury, negative affect, and catastrophizing predicting return to sport in recreational athletes with anterior cruciate ligament injuries at 1 year postsurgery. Rehabil Psychol 1(52):74

    Article  Google Scholar 

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Authors and Affiliations

  1. Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland

    James P. Toale, Eoghan T. Hurley, Andrew J. Hughes, Daniel Withers, Enda King, Mark Jackson & Ray Moran

Authors
  1. James P. Toale
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  2. Eoghan T. Hurley
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  3. Andrew J. Hughes
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  4. Daniel Withers
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  5. Enda King
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  6. Mark Jackson
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  7. Ray Moran
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Correspondence to Eoghan T. Hurley.

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Ethical approval was granted by the Sports Surgery Clinic IRB.

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Toale, J.P., Hurley, E.T., Hughes, A.J. et al. The majority of athletes fail to return to play following anterior cruciate ligament reconstruction due to reasons other than the operated knee. Knee Surg Sports Traumatol Arthrosc 29, 3877–3882 (2021). https://doi.org/10.1007/s00167-020-06407-5

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  • DOI: https://doi.org/10.1007/s00167-020-06407-5

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