Beneficial and limiting factors for return to work following anterior cruciate ligament reconstruction: a retrospective cohort study

Abstract

PurposeEvidence-based advice for return to work (RTW) after anterior cruciate ligament (ACL) reconstruction is not available. Therefore, the objectives of this study were to determine when patients achieve full RTW, and to explore the beneficial and limiting factors for fully RTW after ACL reconstruction.MethodsA retrospective cohort study was performed after ACL reconstruction among 185 patients in one hospital. Data from patient files and a questionnaire were used to explore whether patient-, injury-, surgery-, sports-, work- and rehabilitation-related factors are beneficial or limiting for fully RTW after ACL reconstruction, using a backward stepwise logistic regression analysis.ResultsOf the 125 (68%) patients that returned the questionnaire, 36 were not part of the working population. Of the remaining 89 patients, 82 patients (92%) had returned fully to work at follow-up. The median time to fully RTW was 78 days. In the final regression model, which explained 29% of the variance, a significant OR of 5.4 (90% CI 2.2–13.1) for RTW > 78 days was observed for patients performing heavy knee-demanding work compared to patients performing light knee-demanding work. In addition, a significant and positive OR (1.6, 90% CI 1.2–1.9) for the number of weeks walking with the aid of crutches for RTW > 78 days was observed in the final model.ConclusionAfter ACL reconstruction, 92% of the patients fully return to work at a median time of 78 days. The significant predictors for fully RTW > 78 days are performing heavy knee-demanding work and a longer period of walking aided with crutches after ACL reconstruction.

Examination of Early Functional Recovery After ACL Reconstruction: Functional Milestone Achievement and Self-Reported Function

“…Return to work was relatively fast for employees with medium and heavy occupational physical demands compared with other studies. 17,31 Patients were not given specific parameters for defining their occupational demand, so it is unknown how the classification of medium and heavy occupational physical demand in this study compares with other studies. Return to school was achieved in the fastest median time (1 week postsurgery) of all functional milestones, and all patients met the milestone within 1 month postsurgery.…”

“…The median time for return to work in our study was 11 days postsurgery compared with an average of 11 to 15 weeks postsurgery in previous studies. 17,31 However, most of our sample classified their occupational physical demands as sedentary/light, which would facilitate a faster return to work. Return to work was relatively fast for employees with medium and heavy occupational physical demands compared with other studies.…”

“…Patient and clinician discussion or decision-making related to functional milestone achievement were not monitored in this study. 17…”

“…Similar methodology has been used to report return to work after ACL reconstruction. 17 Patients were only asked questions applicable to them. Once a functional milestone was met, the patient was not asked about it at subsequent testing sessions.…”

“…Moreover, ACL reconstruction protocols often include targets for the discontinuation of crutches, 23,32 but the time frame in which patients discontinue crutches has been reported limitedly. 33 Finally, few or no studies have reported the time frame for returning to work, 17,31 returning to school, or returning to driving after ACL reconstruction. In terms of self-reported function, we identified only 1 study that examined longitudinal change in the early postoperative period after ACL reconstruction, 10 but a preoperative baseline was not included for comparison.…”