Factors affecting return to sport following hamstrings anterior cruciate ligament reconstruction in non-elite athletes

Abstract

Anterior cruciate ligament (ACL) rupture is a common injury affecting non-elite and elite athletes. Although most ACL reconstructions restore the mechanical stability of the injured knee, the rate of return to sport (RTS) is varied. We aimed to identify why non-elite athletes fail to return to pre-injury sport level. The primary objective was to assess the frequency of RTS (including type of sport, timing, level, and duration), and the secondary objective was to assess the surgical (injury, type of surgery, re-injury) and patient (demographics, function, symptoms, social, psychological) factors affecting RTS, using a multivariate analysis. Level III, retrospective cohort study. We evaluated 78 consecutive non-elite athletes undergoing hamstring ACL reconstruction using medical records and questionnaires. Mean follow-up was 50months (24-224months). Athletes were divided into return to sport (RTS) and not returning to sport (NRTS) groups for comparative and multivariate analyses, to identify independent predictors of RTS status. Mean age was 31.5years (18-51), and 46 were male (59%). The RTS rate was 56.4% (44), with most athletes returning between 9 and 12months, and then continuing to play for > 60months. Fear of re-injury was the highest reported reason for NRTS. There were no significant differences in demographics, concomitant injury, adjuvant surgery, and type of sport between the two groups. Mean Tegner scores were significantly higher in RTS group post-injury (6.9 vs 4.6) and at present (6.6 vs 4.6). The International Knee Documentation Committee (IKDC) score for the RTS group also increased significantly from pre-injury 70.8 (49.1-93.4) to 83.9 (24.1-100) post-injury (p < 0.001). Fear of re-injury, lack of confidence, lack of time, and change in job were significant factors in the NRTS group. Playing soccer, giving way, and change of job independently predicted RTS status from multivariate analysis. A significant number of non-elite athletes did not RTS following ACL reconstruction, and this was influenced by a combination of activity level, sport, self-reported knee instability, and psycho-social factors. Importantly, some of these can be predicted and managed with improved, individualized post-operative physical and psychological rehabilitation programmes. These data also allow surgeons to better counsel athletes before ACL reconstruction on their likelihood of RTS.