Factors influencing return to sports after anterior cruciate ligament reconstruction
Article Sidebar
Main Article Content
Abstract
Objectives: to assess the frequency of return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR) and to identify factors influencing RTS in individuals from Karachi, Pakistan.
Methods: This retrospective cohort study included 109 participants who underwent ACLR between January 2016 and June 2021 at Liaquat National Hospital, Karachi, Pakistan. Patients aged 15–35 years with a pre-injury Tegner Activity Scale score of ≥6, a minimum of 12 months post-surgery, and completed rehabilitation were included. Patients with multi-ligamentous injuries or ACL re-ruptures were excluded. Participants were assessed using the Lysholm/Tegner score, the International Knee Documentation Committee (IKDC) subjective knee evaluation form, and the Tampa Scale for Kinesiophobia (TSK-11) to evaluate pre- and post-injury activity levels, knee function, and kinesiophobia, respectively.
Results: Among the 109 participants, 54.1% (n=59) returned to sports at a mean of 9.94±4.73 months post-ACLR; however, only 16.9% (n=10/59) of those who returned were able to achieve pre-injury performance levels. A significant proportion (45.9%, n=50/109) did not return to any level of sports. Those who returned demonstrated significantly higher IKDC (73.76 vs. 67.04, p<0.05) and Lysholm scores (95.45 vs. 85.82, p<0.05), and lower TSK-11 scores (37.44 vs. 44, p<0.05), indicating better knee function and lower kinesiophobia compared to non-RTS individuals.
Conclusion: Despite favorable functional outcomes post-ACLR, only half of the participants returned to sports, with an even lower proportion achieving pre-injury performance levels. Elevated kinesiophobia was significantly associated with reduced knee function and activity levels, emphasizing the need to address psychosocial factors in rehabilitation to improve RTS outcomes.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Work published in KMUJ is licensed under a
Creative Commons Attribution 4.0 License
Authors are permitted and encouraged to post their work online
(e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
References
1. Evans J, Nielson JL. Anterior cruciate ligament knee injury - statpearls - NCBI bookshelf, Anterior Cruciate Ligament Knee Injury. Accessed on: June 11, 2023. Available from URL: https://www.ncbi.nlm.nih.gov/books/NBK499848
2. Marx RG, Jones EC, Angel M, Wickiewicz TL, Warren RF. Beliefs and attitudes of members of the American Academy of Orthopaedic Surgeons regarding the treatment of Anterior Cruciate Ligament Injury. Arthrosc J Arthrosc Relat Surg 2003;19(7):762-70. https://doi.org/10.1016/s0749-8063(03)00398-0
3. Bogunovic L, Matava M. Operative and Nonoperative Treatment Options for ACL Tears in the Adult Patient: A Conceptual Review. Phys Sports Med 2013;41(4):33-40. https://doi.org/10.3810/psm.2013.11.2034
4. 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(1):41-8. https://doi.org/10.1177/0363546511422999
5. Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five percent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 2014;48(21):1543-52. https://doi.org/10.1136/bjsports-2013-093398
6. 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(7):1567-73. https://doi.org/10.1177/0363546514530088
7. Ericsson YB, Roos EM, Frobell RB. Lower extremity performance following ACL rehabilitation in the KANON-trial: impact of reconstruction and predictive value at 2 and 5 years. Br J Sports Med 2013;47(15):980-5. https://doi.org/10.1136/bjsports-2013-092642
8. Burland JP, Toonstra J, Werner JL, Mattacola CG, Howell DM, Howard JS. Decision to Return to Sport After Anterior Cruciate Ligament Reconstruction, Part I: A Qualitative Investigation of Psychosocial Factors. J Athl Train 2018;53(5):452-63. https://doi.org/10.4085/1062-6050-313-16
9. Liew BXW, Feller JA, Webster KE. Understanding the psychological mechanisms of return to sports readiness after anterior cruciate ligament reconstruction. PLoS One 2022;17(3):1-12. https://doi.org/10.1371/journal.pone.0266029
10. Hart HF, Culvenor AG, Guermazi A, Crossley KM. Worse knee confidence, fear of movement, psychological readiness to return to sport, and pain are associated with worse function after ACL reconstruction. Phys Ther Sport 2020;41:1-8. https://doi.org/10.1016/j.ptsp.2019.10.006
11. Alswat MM, Khojah O, Alswat AM, Alghamdi A, Almadani MS, Alshibely A, et al. Returning to Sport After Anterior Cruciate Ligament Reconstruction in Physically Active Individuals. Cureus 2020;12(9):e10466. https://doi.org/10.7759/cureus.10466
12. Paterno MV, Flynn K, Thomas S, Schmitt LC. Self-Reported Fear Predicts Functional Performance and Second ACL Injury After ACL Reconstruction and Return to Sport: A Pilot Study. Sports Health 2017;10(3):228-33. https://doi.org/10.1177/1941738117745806
13. Zampogna B, Vasta S, Torre G, Gupta A, Hettrich CM, Bollier MJ, et al. Return to Sport After Anterior Cruciate Ligament Reconstruction in a Cohort of Division I NCAA Athletes From a Single Institution. Orthop J Sports Med 2021;9(2):[8 p]. https://doi.org/10.1177/2325967120982281
14. Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Sports participation 2 years after anterior cruciate ligament reconstruction in athletes who had not returned to sport at 1 year: A prospective follow-up of physical function and psychological factors in 122 athletes. Am J Sports Med 2015;43(4):848-56. https://doi.org/10.1177/0363546514563282
15. Gokeler A, Dingenen B, Hewett TE. Rehabilitation and Return to Sport Testing After Anterior Cruciate Ligament Reconstruction: Where Are We in 2022? Arthrosc Sports Med Rehabil 2022;4(1):e77-e82. https://doi.org/10.1016/j.asmr.2021.10.025
16. Webster KE, Nagelli CV, Hewett TE, Feller JA. Factors Associated With Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction Surgery. Am J Sports Med 2018;46(7):1545-50. https://doi.org/10.1177/0363546518773757
17. Bley JA, Master H, Huston LJ, Block S, Pennings JS, Coronado RA, et. al. Return to Sports After Anterior Cruciate Ligament Reconstruction: Validity and Reliability of the SPORTS Score at 6 and 12 Months. Orthop J Sports Med 2022;10(6). https://doi.org/10.1177/23259671221098436