Return to Preinjury Sports Participation Following Anterior Cruciate Ligament Reconstruction: Contributions of Demographic, Knee Impairment, and Self-report Measures

Abstract

STUDY DESIGN Cross-sectional cohort. OBJECTIVES (1) To examine differences in clinical variables (demographics, knee impairments, and self-report measures) between those who return to preinjury level of sports participation and those who do not at 1 year following anterior cruciate ligament reconstruction, (2) to determine the factors most strongly associated with return-to-sport status in a multivariate model, and (3) to explore the discriminatory value of clinical variables associated with return to sport at 1 year postsurgery. BACKGROUND Demographic, physical impairment, and psychosocial factors individually prohibit return to preinjury levels of sports participation. However, it is unknown which combination of factors contributes to sports participation status. METHODS Ninety-four patients (60 men; mean age, 22.4 years) 1 year post–anterior cruciate ligament reconstruction were included. Clinical variables were collected and included demographics, knee impairment measures, and self-report questionnaire responses. Patients were divided into “yes return to sports” or “no return to sports” groups based on their answer to the question, “Have you returned to the same level of sports as before your injury?” Group differences in demographics, knee impairments, and self-report questionnaire responses were analyzed. Discriminant function analysis determined the strongest predictors of group classification. Receiver-operating-characteristic curves determined the discriminatory accuracy of the identified clinical variables. RESULTS Fifty-two of 94 patients (55%) reported yes return to sports. Patients reporting return to preinjury levels of sports participation were more likely to have had less knee joint effusion, fewer episodes of knee instability, lower knee pain intensity, higher quadriceps peak torque-body weight ratio, higher score on the International Knee Documentation Committee Subjective Knee Evaluation Form, and lower levels of kinesiophobia. Knee joint effusion, episodes of knee instability, and score on the International Knee Documentation Committee Subjective Knee Evaluation Form were identified as the factors most strongly associated with self-reported return-to-sport status. The highest positive likelihood ratio for the yes-return-to-sports group classification (14.54) was achieved when patients met all of the following criteria: no knee effusion, no episodes of instability, and International Knee Documentation Committee Subjective Knee Evaluation Form score greater than 93. CONCLUSION In multivariate analysis, the factors most strongly associated with return-to-sport status included only self-reported knee function, episodes of knee instability, and knee joint effusion.

Young Athletes Cleared for Sports Participation After Anterior Cruciate Ligament Reconstruction: How Many Actually Meet Recommended Return-to-Sport Criterion Cutoffs?

“…23 Similarly, when using the IKDC, studies have shown that higher proportions of athletes have returned to sport following ACL reconstruction when their IKDC scores were greater than 90. 36 Therefore, the criterion cutoff used in this study for the IKDC was a score of 90 or greater.…”

“…15 Importantly, previous work has found that individuals who returned to their preinjury level of sports participation after ACL reconstruction had a higher IKDC score (93.8 ± 6.3) than those who did not return to their preinjury level of sports participation (78.0 ± 15.6). 36 While previous studies have reported proportions of individuals after ACL reconstruction who meet cutoffs for various measures, 23,57 the number of young athletes meeting recommended criterion cutoffs at the specific time of return-tosport clearance and the impact of meeting criterion cutoffs on longitudinal sports participation remain unreported. This is particularly important, given suboptimal return-to-sport outcomes over time following ACL reconstruction.…”

“…25,38,39,51,53,57 While recommendations for strength prior to return to sports often involve LSIs, previous work examining the relationship between strength and return to sports has primarily found that involved-limb peak torque is related to return to sports. At 1 year post ACL reconstruction, Lentz et al 36 reported that those with higher involved-limb quadriceps torque were more likely to return to preinjury level of sports participation than those who had lower-involved limb quadriceps torque values. Similarly, at 1.5 to 2 years following ACL reconstruction, higher hamstring peak torque was found to be correlated with a higher Tegner activity score.…”

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“…Probably, ACL not only prevents tibial displacement to anterior position to avoid instability in other directions such as valgus and varus but also play a major role in individual sense of stability toward the knee. [9] Therefore, relying on anterior drawer and Lachman test results as [10] Since Lysholm score generally and comprehensively evaluates several indicators such as pain, locking the knee, and swelling, these scores are used as the most important indices in evaluating surgical results and the patients' satisfaction. Relying on the knee instability tests alone cannot ensure the success of the treatment and knee function.…”

Relation of Self-Reported Knee Function and Physical Performance with Psychological Responses in Anterior Cruciate Ligament Reconstructed Individuals

“…Demographic, physical and psychological factors have shown to affect RTS rate following ACL reconstruction (5). Previous studies suggested that only detecting side to side asymmetries by using physical performance tests is not adequate for RTS decision (6)(7)(8)(9)(10).…”