Comparison of Two Methods to Measure Return to Sports after Anterior Cruciate Ligament (ACL) Reconstruction

Abstract

Objectives:Return to sports (RTS) is a primary goal for ACL reconstruction. Recent studies indicate that return to prior level of sports participation is poor with only 45% of patients having returned to sport.1 The purpose of this study was to evaluate return to pre-injury level of sports participation after ACL reconstruction using a strict comprehensive definition for RTS.Methods:Participants who were 1 to 5 years after ACL reconstruction completed a survey to determine their pre-and post-surgery sports activity levels. Comprehensive return to pre-injury level of sports (comprehensive RTS) was operationally defined as returning to the same type and frequency of sports and same Marx Activity Score (MAS) as before injury. Patients also answered a global question on whether they had returned to their pre-injury level of sports (global RTS). The International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) was used to compare symptoms and function between patients who did and did not meet comprehensive RTS criteria.Results:One hundred sixty eight participants (mean age, 28.8±10.9 years) completed the survey. Using comprehensive RTS criteria, 69 (41.1%) participants returned to their pre-injury level of sports. Based on the global RTS, 79 (47%) reported they had returned to their pre-injury level of sports. Fifty nine (74.7%) of the 79 individuals that reported global RTS met the comprehensive RTS criteria. Patients who met the comprehensive RTS criteria had fewer symptoms and better function based on the IKDC-SKF than those who did not (87.5±10.6 vs. 80.1±13.7, p<0.001). Of the 93 patients who did not meet comprehensive RTS criteria, 46 (49.5%) did not return because of fear of re-injury, 32 (34.4%) due to ongoing problems with their knee, 31 (31.3%) lacked confidence in the knee, 20 (21.5%) work or family obligations, and 6 (6.5%) were no longer eligible for participation in competitive sports.Conclusion:RTS is more common if based on a global RTS question than if measured by strict comprehensive criteria that combine return to the same type and frequency of sports and MAS. Patients who do not meet comprehensive RTS criteria demonstrate poorer function than those that do. A global rating of RTS may overestimate the true RTS rate by 25%. Fear of re-injury, ongoing knee problems, and lack of confidence play a greater role in preventing RTS than lifestyle changes. These issues need to be addressed to improve RTS after ACL reconstruction