How to assess the return to physical activities following anterior cruciate ligament injury?

Abstract

Several outcomes could be used to assess return to physical activities (RTPA) after anterior cruciate ligament (ACL) injury: qualitative outcomes like return to main sport or pre-injury level; quantitative outcomes like weekly hours of practice or Tegner score. Performing a relevant clinical assessment is challenging, especially for patients who practice at a moderate sport level. Our objective was to compare the use of different outcomes to assess RTPA after functional and surgical treatment of ACL injury. Forty patients were included after surgery (group ST; 31.7 ± 10.6 years-old, 15.0 ± 5.0 months after ACL reconstruction);18 after functional treatment (group FT; 38.1 ± 14.8 years-old, 23.0 ± 6.0 months after ACL tear). Qualitative criteria were subjectively assessed answering yes/no when questioned concerning their RTPA. Objective criteria were defined as variations between pre-injury and post-treatment of Tegner score, weekly hours of practice, “Tegner.h” (global volume of activity equal to Tegner score multiplied by weekly hours of practice) for main physical activity (MPA) and global activity (3 MPA included). Return to subjective global pre-injury level was 22% for FT group vs. 25% for ST group ( P = 0.999). Return to pre-injury (i) level of MPA was 17 vs. 23% ( P = 0.736); (ii) Tegner score for the MPA was 56 vs. 30% ( P = 0.083); and (iii) global Tegner.h was 61 vs. 18% ( P = 0.002) for FT versus ST group, respectively. Evolution of Global Tegner.h score, MPA Tegner.h score and Global weekly hours of practice were congruent for FT group, but not for ST group. We found low RTPA rates with some discrepancies between different outcomes of RTPA. Global Tegner.h could be an interesting alternative to Tegner score of the MPA for assessment of RTPA in non-operated patients who have a moderate physical activity level.