Factors Related to Return to Sport at One Year after Anterior Cruciate Ligament Reconstruction
Keywords:
anterior cruciate ligament reconstruction, rehabilitation, return to sport, single leg hop testAbstract
Objectives: To investigate rates of return to pre-injury sport (RTS) level at around one year after anterior cruciate ligament reconstruction (ACLR) and completing a rehabilitation program for post-ACLR and related factors.
Study design: Retrospective case control study.
Setting: Department Rehabilitation Medicine, Suratthani Hospital.
Subjects: Patients who underwent ACLR and completed the rehabilitation program, had a pre-injury Tegner Activity Scale (TAS) level 5 or higher, had normal Lachman test, and 4 single leg hop tests done.
Methods: Demographic data and results of 4 single leg hop tests were extracted from the recruited patients’ medical records. Limb symmetry index (LSI) was calculated from the 4 single leg hop tests. The recruited patients were divided into two groups, the RTS and the non-RTS groups, and data were compared between the two groups.
Results: There were 40 patients in the RTS group and 31 in the non-RTS group. The RTS rates were 56.3% in average, 57.4% for football, 62.5% for running, and 16.7% for basketball. The RTS group had younger age (mean age of 23.5 and 29.0 years, p = 0.01), more athletes (37.5% and 12.9%, p = 0.03), higher percentage of LSI > 90% of all 4 single leg hop tests (77.5% and 29.0%, p = 0.00) than the non-RTS group. Mean duration from operation to the last 4 single leg hop tests was 10.4 months for the RTS group. One reason of being unable to RTS was fear of re-injury (67.7%).
Conclusion: The overall rate of return to pre-injury sport level was 56.3%. Younger age and achieving LSI more than 90% of all 4 single leg hop tests were factors related to RTS at around one year after ACLR and receiving postoperative rehabilitation. Fear of re-injury was a major reason for not returning to pre-injury sports activity.
Keywords: anterior cruciate ligament reconstruction, rehabilitation, return to sport, single leg hop test
References
Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy. 2011;27:1697-705.
Wilk KE, Macrina LC, Cain EL, Dugas JR, Andrews JR. Recent advances in the rehabilitation of anterior cruciate ligament injuries. J Orthop Sports Phys Ther. 2012;42:153-71.
Shea KG, Carey JL, Richmond J, Sandmeier R, Pitts RT, Polousky JD, et al. The American Academy of Orthopaedic Surgeons evidence-based guideline on management of anterior cruciate ligament injuries. J Bone Joint Surg Am. 2015;97:672-4.
Doyle K, King E, Wilson F. Factors which influence return to sport following anterior cruciate ligament (ACL) reconstruction surgery: a narrative review. Int Sport Med J. 2013;14:168-84.
Saha PK. Analysis of factors affecting return to sports after anterior cruciate ligament reconstruction: a prospective clinical investigation. Int J Sci Stud. 2016;4:11-7.
Edwards PK, Ebert JR, Joss B, Ackland T, Annear P, Buelow JU, et al. Patient characteristics and predictors of return to sport at 12 months after anterior cruciate ligament reconstruction. Orthop J Sports Med. 2018;6. doi:10.1177/2325967118797575
Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five percent return to competitive sport following anterior cruciate ligament surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014;48:1543–52.
Ballal MS, Khan Y, Hastie G, Hatcher A, Coogan S, McNicholas MJ. Functional outcome of primary hamstring anterior cruciate ligament reconstruction in patients with different body mass index classes. Arthroscopy. 2013;29:1314-21.
Schmitt LC, Paterno MV, Hewett TE. The impact of quadriceps femoris strength asymmetry on functional performance andreturn to sport following anterior cruciate ligament reconstruction. J Orthop Sport Phys Ther. 2012;42:750-9.
Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med. 2016;50:946-51.
Van Melick N, van Cingel RE, Brooijmans F, Neeter C, van Tienen T, Hullegie W, et al. Evidence based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med. 2016;50:1506–15.
Thomee R, Neeter C, Gustavsson A, Thomee P, Augustsson J, Eriksson B, et al. Variability in leg muscle power and hop performance after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2012;20:1143-51.
Abrams GD, Harris JD, Gupta AK, McCormick FM, Bush-Joseph CA, Verma NN, et al. Functional performance testing after anterior cruciate ligament reconstruction a systematic review. Orthop J Sports Med. 2014;2. doi: 10.1177/2325967113518305.
Logerstedt D, Grindem H, Lynch A, Eitzen I, Engebretsen L, Risberg MA, et al. Single-legged hop tests as predictors of self-reported knee function after anterior cruciate ligament reconstruction: the Delaware-Oslo ACL cohort study. Am J Sports Med. 2012;40: 2348-56.
Reid A, Birmingham TB, Stratford PW, Alcock GK, Giffin JR. Hop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction. Phys Ther. 2007;87:337-49.
Zwolski C, Schmitt LC, Thomas S, Hewett TE, Paterno MV. The utility of limb symmetry indices in return-to-sport assessment in patients with bilateral anterior cruciate ligament reconstruction. Am J Sports Med. 2016;44:2030-8.
Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50:804-8.
Richmond JC. Anatomic single-bundle anterior cruciate ligament reconstruction. In: Hunter RE, Sgaglione NA, editors. AANA advanced arthroscopy the knee. Philadephia: Saunders Elsevier; 2010. P.184-90.
Webster KE, Feller JA, Hartnett N, Leigh WB, Richmond AK. Comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction: a 15-year follow-up of a randomized controlled trial. Am J Sports Med. 2016; 44:83-90.
Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43–9.
Janewanitsataporn S. The functional tests after ACL reconstruction with and without meniscal repair. J Health Sci Med Res. 2020;2:73-9.
Seto JL, Orofino AS, Morrissey MC, Medeiros JM, Mason WJ. Assessment of quadriceps/hamstring strength, knee ligament stability, functional and sports activity levels five years after anterior cruciate ligament reconstruction. Am J Sports Med. 1988;16:170-80.
Ardern CL, Taylor NF, Feller JA, Webster KE. Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2012;40:41-8.
Smith FW, Rosenlund EA, Aune AK, MacLean JA, Hillis SW. Subjective functional assessments and the return to competitive sport after anterior cruciate ligament reconstruction. Br J Sports Med. 2004;38:279–84.
Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Am J Sports Med. 2014;42:1567-73.
Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. 2016;44:1861-76.
Ardern CL, Taylor NF, Feller JA, Webster KE. A systematic review of the psychological factors associated with returning to sport following injury. Br J Sports Med. 2013;47:1120-6.
