High variability and lack of standardization in the evaluation of return to sport after ACL reconstruction: a systematic review

Abstract

PurposeReturn to sport (RTS) after ACL reconstruction (ACLR) has been recognized as an important outcome, which is associated with success of the surgery. This study aimed to assess the methods used to determine return to sport after ACLR in the published literature, report on variability of methods and evaluate their strength in establishing accurate RTS data. MethodsElectronic databases (PubMed, Cochrane Library and Embase) were searched via a defined search strategy with no limits, to identify relevant studies from January 2008 to December 2020 for inclusion in the review. Defined eligibility criteria included studies specifically measuring and reporting on return to sport after ACLR with a clear methodology. Each included study was assessed for the definition of successful RTS, successful return to pre‐injury level of sport and for methods used to determine RTS. ResultsOne hundred and seventy‐one studies were included. Of the included studies, six studies (4%) were level of evidence 1 and seventy‐two studies (42%) were level of evidence 4. Forty‐one studies (24%) reported on return to a specific sport and 130 studies (76%) reported on return to multiple sports or general sport. Sixteen studies (9%) reported on RTS in the pediatric population, 36 (21%) in the adult population and 119 (70%) reported on a mixed‐aged population. The most commonly used definition of successful RTS was return to the same sport (44 of 125 studies, 35%). The most common method used to determine RTS was a non‐validated study‐specific questionnaire (73 studies, 43%), which was administered in various ways to the patients. Time of RTS assessment was variable and ranged between 6 months and 27 years post‐surgery. ConclusionThis review demonstrates high variability in defining, evaluating and reporting RTS following ACLR. The findings of this study reveal low reliability and unproven validity of methods used to evaluate RTS and highlight the challenges in interpreting and using RTS data reported in literature. Level of evidenceIV.

“I don't opt out of things because I think I will get a sore knee, but I don't expose myself to stupid risks either”: patients’ experiences of a second ACL injury—an interview study

“…ACL rupture is the most common knee ligament injury [ 36 ], and where individuals intend returning to sport, they are usually recommended for ACL reconstruction (ACLR) and rehabilitation [ 23 ]. After these, individuals are expected to be able to return to sport [ 33 ], but the time of return to sport varies between 6 months and 27 years [ 22 ]. Long-term negative effects include reduced physical activity and quality of life (QOL) [ 7 ], and increased risk of osteoarthritis [ 34 ].…”

Anterior Cruciate Ligament Reconstruction in 107 Competitive Wrestlers: Outcomes, Reoperations, and Return to Play at 6-Year Follow-up

“… 3 , 10 , 29 Noted discrepancies across studies are often based on age, sex, specific sport, level of participation, and differences in surgical technique and postoperative rehabilitation. 6 , 21 , 24 , 28 – 30 Ardern et al 3 examined a cohort of 314 competitive athletes, demonstrating 93% RTS at both the competitive and the recreational levels. Lai et al 24 found that, in general, 83% of elite athletes (professional, National Collegiate Athletic Association Division I, or highest level of competition for their sport) were able to RTS after ACLR within 12 months.…”

Superior results of return to sport after double-bundle versus single-bundle anterior cruciate ligament reconstruction in young active patients

“…Among patients undergoing DB vs. SB ACLR, some previous studies [ 16 ] demonstrated no significant differences in return to sport outcome between the two techniques. Some of these observed discrepancies in return to sport outcomes can be attributed to different patient populations (age, sex, specific sport, level of participation in sports and more) and different study methodologies [ 13 ]. In this work, return to sport is defined as return to running and return to pivoting sport, respectively.…”