Returning to sport after ACL reconstruction varies according to different physical functioning and contextual factors

Abstract

Introduction: In 2011 we published a systematic review and meta-analysis of return to sport rates from 48 studies including over 5500 patients who had anterior cruciate ligament (ACL) reconstruction. This review demonstrated that the return to sport rate following surgery was lower than previously expected, and highlighted the relative lack of emphasis on evaluating participation-based outcomes after ACL reconstruction. Since the original review, returning to sport has received increased research attention, suggesting that an update to the review was warranted. Therefore, the objectives were to update our original review of return to sport rates following ACL reconstruction, and to add to the original review by investigating the relationship between returning to sport, and aspects of physical functioning and contextual factors.Methods: Electronic databases were systematically searched from April 2010 to November 2013 for articles reporting the number of patients returning to sport following ACL reconstruction. Return to sport rates, physical functioning, and contextual data were extracted and combined using random-effects meta-analyses. Data from the original review (studies published up to April 2010) were combined with data from the updated search.Results: Sixty-nine articles, reporting on 7556 participants were reviewed (48 from the original review and 21 from the updated search). On average, 81% of people returned to some kind of sport, 65% returned to their preinjury sport, and 55% returned to competitive sport. Symmetrical hopping performance (d = 0.3), younger age (d = −0.3), male sex (odds ratio = 1.4), playing elite level sport (odds ratio = 2.5), and having a positive psychological response (low fear of re-injury and greater psychological readiness to return to sport) (d = 0.3) favoured returning to the preinjury sport. Receiving a hamstring tendon autograft favoured returning to competitive sport (odds ratio = 2.4), and receiving a patellar tendon autograft favoured returning to the preinjury sport (odds ratio = 1.2).Discussion: Data from over 7000 individuals demonstrated that one in five people did not return to any sport, one in three did not return to their preinjury sport, and one in two did not return to competitive sport following ACL reconstruction. Returning to sport varied according to contextual factors as well as physical functioning, suggesting that these factors may warrant additional emphasis in post-operative rehabilitation to improve return to sport rates. Introduction: In 2011 we published a systematic review and meta-analysis of return to sport rates from 48 studies including over 5500 patients who had anterior cruciate ligament (ACL) reconstruction. This review demonstrated that the return to sport rate following surgery was lower than previously expected, and highlighted the relative lack of emphasis on evaluating participation-based outcomes after ACL reconstruction. Since the original review, returning to sport has received increased research attention, suggesting that an update to the review was warranted. Therefore, the objectives were to update our original review of return to sport rates following ACL reconstruction, and to add to the original review by investigating the relationship between returning to sport, and aspects of physical functioning and contextual factors. Methods: Electronic databases were systematically searched from April 2010 to November 2013 for articles reporting the number of patients returning to sport following ACL reconstruction. Return to sport rates, physical functioning, and contextual data were extracted and combined using random-effects meta-analyses. Data from the original review (studies published up to April 2010) were combined with data from the updated search. Results: Sixty-nine articles, reporting on 7556 participants were reviewed (48 from the original review and 21 from the updated search). On average, 81% of people returned to some kind of sport, 65% returned to their preinjury sport, and 55% returned to competitive sport. Symmetrical hopping performance (d = 0.3), younger age (d = −0.3), male sex (odds ratio = 1.4), playing elite level sport (odds ratio = 2.5), and having a positive psychological response (low fear of re-injury and greater psychological readiness to return to sport) (d = 0.3) favoured returning to the preinjury sport. Receiving a hamstring tendon autograft favoured returning to competitive sport (odds ratio = 2.4), and receiving a patellar tendon autograft favoured returning to the preinjury sport (odds ratio = 1.2). Discussion: Data from over 7000 individuals demonstrated that one in five people did not return to any sport, one in three did not return to their preinjury sport, and one in two did not return to competitive sport following ACL reconstruction. Returning to sport varied according to contextual factors as well as physical functioning, suggesting that these factors may warrant additional emphasis in post-operative rehabilitation to improve return to sport rates.