Return to Sport Rate is Less Than Might be Anticipated Following ACL Reconstruction Surgery

Abstract

An athlete's intention to return to sport following anterior cruciate ligament (ACL) injury is a major indication for surgical intervention. Despite this, information regarding the rate of return to the pre-injury sports participation level following ACL injury and surgery is limited. PURPOSE: To determine the effect of ACL reconstruction surgery on post-operative return to sport outcomes. METHODS: A systematic review was conducted, and electronic databases including Medline, Embase, SPORTDiscus and CINAHL were searched from the earliest possible entry to April 2009. All studies that reported the number of patients returning to sports participation following ACL reconstruction surgery were included. The results were combined using a proportion meta-analysis. RESULTS: Forty-eight studies evaluating 5770 participants were identified. Overall, 82.2% of participants had returned to some kind of sports participation, 63.3% had returned to their pre-injury level of participation and 44.4% had returned to competitive sport at final follow up. On the other hand, approximately 90% of participants achieved good post-operative knee function when assessed using measures such as knee laxity, thigh muscle strength and International Knee Documentation Committee knee evaluation form. Fear of re-injury was the most common reason cited for a post-operative reduction in or cessation of sports participation. CONCLUSIONS: The relatively low rate of return to competitive sport raises the question whether ACL reconstruction surgery is indicated in all patients currently receiving this intervention. These results also suggest that psychological factors may warrant greater attention during the post-operative rehabilitation phase.