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Less Than 50% Return To Sport At Pre-Injury Level After ACL Surgery

Return at 12 months not predictive of participation in medium term between 2 and 7 years

Less than half of athletes return to their pre-injury level or to competitive sports in the period 2 to 7 years after ACL reconstruction surgery, although younger athletes return at a higher rate, reports a new Australian study.1

Previous studies by the same Australian researchers showed that the rate of return to competitive sport at 12 months after ACL reconstruction at between 49% and 92%, depending on how return to competitive sport was defined.  Previous research had also produced conflicting results regarding gender differences in return to sport after such surgery, with one study showing similar return rates between male and female athletes, but another reporting males returning to sport earlier than females. Knee pain

Key findings

The new study found that:

  • 93% attempted some form of sports participation in the medium term between 2 and 7 years after surgery;
  • Most reported good recovery of function and few knee symptoms;
  • Only 41% had attempted competitive sport at some time after surgery;
  • 61% had attempted sport at their preinjury level;
  • As in previous studies, those with good postoperative knee function were no more likely than those with poor knee function to have returned to sport at the one-year mark post-surgery.
  • Only 29% (and 46% of those who played competitive sport before injury) were actively playing competitive-level sport at follow-up;
  • Younger participants were more likely to have returned to their preinjury sports participation than older participants.
  • No gender differences in medium-term return-to-sport outcomes were, although the results were consistent with earlier studies finding that female athletes may take longer than males to return to sport, with males significantly more likely than women to have returned to sport by the 12-month milepost after surgery.
  • The rate of return to competitive sport increases over time: at 12 months, 33% had returned, at 39 months, the rate was 46%, a finding the authors said supported the notion that 12 months' follow-up was too early to accurately evaluate the return-to-sport outcomes after ACL reconstruction.
  • More than half of those who did not return to their pre-injury level of sports participation did so because of the function of their operated knee.  Other factors such as lifestyle change or occupational demands also play a significant role in determining whether an individual continues to participate in sport in the longer term after surgery.

Overall rate of return is low

"The current study demonstrates that overall, the return-to-sport rate in the medium-term follow-up appears to remain relatively low (less than 50%) and only somewhat better than the level achieved at 12 months after surgery.  Further, an individual patient's participation at 12 months is not predictive of whether that individual will be participating in the medium term after surgery," said lead author, Claire L. Adern, of the School of Physiotherapy at La Trobe University, Bundoora, Victoria, Australia. "This means 12 months is too early to judge the success of ACL reconstruction surgery for an individual patient." 

1. Arden CL, Taylor N, Feller J, Webster K. Return-to-Sport Outcomes at 2 to 7 Years After Anterior Cruciate Ligament Reconstruction Surgery.  Am. J. Sports Med 2011;20(10)(published online before print September 23, 2011).

Posted September 25, 2011