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DOI: 10.1055/a-2333-1490
Factors Associated with Return to Sport After Anterior Cruciate Ligament Reconstruction: A Focus on Athletes Who Desire Preinjury Level of Sport
Funding None.![](https://www.thieme-connect.de/media/jks/EFirst/lookinside/thumbnails/10-1055-a-2333-1490_23apr0047oa-1.jpg)
Abstract
Introduction In most previous studies investigating return to preinjury level of sport (RTPS) after anterior cruciate ligament reconstruction (ACLR), whether patients continue aiming for RTPS not only before but also after ACLR was unclear because environmental and social factors were not considered. Herein, we aimed to evaluate factors associated with RTPS among athletes who desired to achieve RTPS even after ACLR, excluding patients who no longer desire this goal owing to environmental and social factors.
Methods Ninety-two patients who underwent primary double-bundle ACLR with a minimum 2-year follow-up and desired to achieve RTPS before surgery were retrospectively enrolled. Twelve (13%) patients who no longer desired to achieve RTPS after ACLR owing to environmental and social factors were excluded. Sixty-nine patients were included in the final cohort. At the final follow-up, the patients were split into two groups: those who achieved (R group) or did not achieve (N group) RTPS based on patient self-assessment. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Lysholm scores were also determined. The anterior tibial translation in the Lachman test and acceleration and external rotational angular velocity (ERAV) in the pivot shift test were measured at the hardware removal operation.
Results Significant differences were observed for preinjury level of sports between the groups (p < 0.05). The rate of RTPS in competitive athletes was lower than that in recreational athletes (20/46: 43% vs. 16/22: 73%; p =.037). Lysholm score, KOOS symptom, pain, and quality of life showed higher values in the R group than in the N group (p < 0.050). Acceleration was significantly lower in the R group than in the N group (p = 0.028).
Conclusion Competitive level of sports is a risk factor for failure to achieve RTPS. The postoperative functional outcomes in the group that achieved RTPS showed more favorable results. These results provide important information to enable the surgeons to consider the appropriate surgical plan for competitive athletes who desire to achieve RTPS after ACLR.
Keywords
return to preinjury sport level - pivot shift test - anterior cruciate ligament - quantitative measurementEthics Approval
All procedures were performed at the dissection room of the Nagoya City University and ethical approval was obtained (IRB number 60–18–0154).
Publication History
Received: 28 April 2023
Accepted: 23 May 2024
Accepted Manuscript online:
24 May 2024
Article published online:
14 June 2024
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References
- 1 Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy 2011; 27 (12) 1697-1705
- 2 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 (15) 946-951
- 3 Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 2011; 45 (07) 596-606
- 4 Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med 2013; 41 (07) 1549-1558
- 5 Toale JP, Hurley ET, Hughes AJ. et al. The majority of athletes fail to return to play following anterior cruciate ligament reconstruction due to reasons other than the operated knee. Knee Surg Sports Traumatol Arthrosc 2021; 29 (11) 3877-3882
- 6 Faleide AGH, Magnussen LH, Bogen BE. et al. Association between psychological readiness and knee laxity and their predictive value for return to sport in patients with anterior cruciate ligament reconstruction. Am J Sports Med 2021; 49 (10) 2599-2606
- 7 Webster KE, McPherson AL, Hewett TE, Feller JA. Factors associated with a return to preinjury level of sport performance after anterior cruciate ligament reconstruction surgery. Am J Sports Med 2019; 47 (11) 2557-2562
- 8 Harris JD, Abrams GD, Bach BR. et al. Return to sport after ACL reconstruction. Orthopedics 2014; 37 (02) e103-e108
- 9 Müller U, Krüger-Franke M, Schmidt M, Rosemeyer B. Predictive parameters for return to pre-injury level of sport 6 months following anterior cruciate ligament reconstruction surgery. Knee Surg Sports Traumatol Arthrosc 2015; 23 (12) 3623-3631
- 10 Nawasreh Z, Logerstedt D, Cummer K, Axe M, Risberg MA, Snyder-Mackler L. Functional performance 6 months after ACL reconstruction can predict return to participation in the same preinjury activity level 12 and 24 months after surgery. Br J Sports Med 2018; 52 (06) 375
- 11 Piefer JW, Pflugner TR, Hwang MD, Lubowitz JH. Anterior cruciate ligament femoral footprint anatomy: systematic review of the 21st century literature. Arthroscopy 2012; 28 (06) 872-881
- 12 Kawanishi Y, Nozaki M, Kobayashi M. et al. Preoperative knee instability affects residual instability as evaluated by quantitative pivot-shift measurements during double-bundle ACL reconstruction. Orthop J Sports Med 2020; 8 (10) 2325967120959020
- 13 Kawanishi Y, Kobayashi M, Yasuma S. et al. Anterolateral ligament reconstruction in addition to primary double-bundle anterior cruciate ligament reconstruction for grade 3 pivot shift improves residual knee instability during surgery. J Exp Orthop 2021; 8 (01) 51
- 14 Murase A, Nozaki M, Kobayashi M. et al. Comparison of quantitative evaluation between cutaneous and transosseous inertial sensors in anterior cruciate ligament deficient knee: a cadaveric study. J Orthop Sci 2017; 22 (05) 874-879
- 15 Petrigliano FA, Borgstrom PH, Kaiser WJ, McAllister DR, Markolf KL. Measurements of tibial rotation during a simulated pivot shift manoeuvre using a gyroscopic sensor. Knee Surg Sports Traumatol Arthrosc 2015; 23 (08) 2237-2243
- 16 Hefti F, Müller W, Jakob RP, Stäubli HU. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1993; 1 (3–4): 226-234
- 17 Novaretti JV, Franciozi CE, Forgas A, Sasaki PH, Ingham SJM, Abdalla RJ. Quadriceps strength deficit at 6 months after ACL reconstruction does not predict return to preinjury sports level. Sports Health 2018; 10 (03) 266-271
- 18 Muller B, Yabroudi MA, Lynch A. et al. Defining thresholds for the patient acceptable symptom state for the IKDC subjective knee form and KOOS for patients who underwent ACL reconstruction. Am J Sports Med 2016; 44 (11) 2820-2826
- 19 Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 2013; 48 (03) 452-458
- 20 Ardern CL, Webster KE, Taylor NF, Feller JA. Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med 2011; 39 (03) 538-543
- 21 Jerre R, Ejerhed L, Wallmon A, Kartus J, Brandsson S, Karlsson J. Functional outcome of anterior cruciate ligament reconstruction in recreational and competitive athletes. Scand J Med Sci Sports 2001; 11 (06) 342-346
- 22 Nakamura K, Koga H, Sekiya I. et al. Evaluation of pivot shift phenomenon while awake and under anaesthesia by different manoeuvres using triaxial accelerometer. Knee Surg Sports Traumatol Arthrosc 2017; 25 (08) 2377-2383
- 23 van Brakel WH, Anderson AM, Mutatkar RK. et al. The participation scale: measuring a key concept in public health. Disabil Rehabil 2006; 28 (04) 193-203
- 24 Yasuma S, Nozaki M, Murase A. et al. Anterolateral ligament reconstruction as an augmented procedure for double-bundle anterior cruciate ligament reconstruction restores rotational stability: quantitative evaluation of the pivot shift test using an inertial sensor. Knee 2020; 27 (02) 397-405
- 25 Chen J, Xu C, Cho E, Huangfu X, Zhao J. Reconstruction for chronic ACL tears with or without anterolateral structure augmentation in patients at high risk for clinical failure: a randomized clinical trial. J Bone Joint Surg Am 2021; 103 (16) 1482-1490
- 26 Rosenstiel N, Praz C, Ouanezar H. et al. Combined anterior cruciate and anterolateral ligament reconstruction in the professional athlete: clinical outcomes from the scientific anterior cruciate ligament network international study group in a series of 70 patients with a minimum follow-up of 2 years. Arthroscopy 2019; 35 (03) 885-892
- 27 Beletsky A, Naami E, Lu Y. et al. The patient acceptable symptomatic state in primary anterior cruciate ligament reconstruction: predictors of achievement. Arthroscopy 2021; 37 (02) 600-605