1. In this cross-sectional study, those with lower knee extension strength, lower pre-injury activity level, greater knee pain, shorter time between injury and surgery, and fear of re-injury had worse sports functioning at 12 months after anterior cruciate ligament (ACL) reconstruction.
2. Although a weaker association, poorer patient psychological readiness also impacted the return to sports.
Evidence Rating Level: 3 (Average)
One of the most common sports injuries requiring surgical management is anterior cruciate ligament (ACL) injury. These injuries present with a heavy physical and psychological toll. Given this, ensuring patients complete objective recovery checkpoints, as well as subjective reported outcomes, is essential to prevent re-injury. However, there is a lack of studies that outline the impact of relevant patient demographic factors, objective factors of physical functioning, and patient-reported knee function on return to sports. This cross-sectional study aimed to determine the impact of the aforementioned factors on sports-related functioning and return to sports.
Of the 618 participants invited, 143 were included in the study. Inclusion criteria were individuals 8-16 months post-ACL repair and age 15-35 years. Exclusion criteria were previous ACL injuries, other diseases impacting physical functioning, and not understanding Scandinavian or English. Patient demographics, including sex and time between injury and surgery, were collected. The Tegner activity scale was used to assess activity levels pre-injury and one-year post-ACL repair. Physical functional assessments included ankle and hip range of motion (ROM), isokinetic muscle strength, and hop performance at 12 months following surgery. The Knee injury and Osteoarthritis Outcome Score (KOOS) Sport and Recreation subscale were used as an outcome measure for sports function. The ACL Return to Sport after Injury (ACL-RSI) scale was used to assess psychological readiness. The primary outcome was the association between these various factors and the return to sports and sports functioning at 12 months.
The results demonstrated that lower isokinetic knee extension strength, lower pre-injury activity levels, greater knee pain, and shorter time between injury and ACL reconstruction all significantly and greatly contributed to worse sports function 12 months following ACL reconstruction, indicated by lower KOOS Sport and Recreation subscale scores. Lower psychological readiness was weakly associated with a shorter side hop and a single-leg hop for distance (SLHD). However, the study may be subject to selection bias since 615 participants were invited, and only 143 were included. Nonetheless, this study offered insights into significant factors that affect sports functioning and the return to sports 12 months following ACL repair.
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