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

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 deined 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 ifty-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 modiiable 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.

Effect of Anterolateral Structure Augmentation on Graft Maturity After Anterior Cruciate Ligament Reconstruction: A Clinical and MRI Follow-up of 2 Years

“…6,44 The differences might be because of the diversity of demographic characteristics among studies, given that younger athletic patients with acute ACL injuries are more likely to return to preinjury sports. 31 Compared with the findings of Chen et al, 6 the present study revealed a higher rate of return to pivoting sports and a lower rate of residual pivot shift or clinical failure in the ACLR group. This might be attributed to the different inclusion criteria, wherein our study population had more acute ACL injuries and less morphological abnormity or high-grade preoperative knee laxity.…”

Predicting the Objective and Subjective Clinical Outcomes of Anterior Cruciate Ligament Reconstruction: A Machine Learning Analysis of 432 Patients

“…In contrast, long chronicity of ACL tear has been reported to result in a lower rate of return to sports and a higher rate of long-term osteoarthritis after ACLR. 4,24 Therefore, ascertaining the principal requirement among these outcomes and managing the expectations for surgical treatment are crucial. For instance, the top priority for young, competitive athletes who have acute ACL tears is to return to preinjury levels of sport rather than to achieve MCIDs, and early surgical treatment with personalized rehabilitation schemes adjusted for the risk of clinical failure may be optimal.…”

“…4,15,20,32,33 Sports levels, baseline patient-reported outcome measures (PROMs), preoperative knee laxity, surgical procedures, and postoperative rehabilitation have been revealed to highly correlate with these clinical outcomes of ACLR. 1,6,11,21,24 However, the discrepant absolute or relative risks of every single predictor resulting from regression analyses in different studies are confusing in clinical practice. Clinicians may find it difficult to predict a specific outcome with an exact likelihood and improve the treatment scheme based on just 1 or 2 risk factors in a patient.…”

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.…”