Age, psychological readiness may predict return to sport after ACL reconstruction
Published results showed age and psychological readiness had a better predictive value of return to sport 2 years after ACL reconstruction than functional tests, which had no predictive value.
Anne Gro Heyn Faleide, PT, MSC, and colleagues collected single-leg hop test, isokinetic strength test, the IKDC Subjective Knee Form 2000, a custom-made return to sport questionnaire and the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale among 129 patients who underwent ACL reconstruction. Researchers defined return to sport criteria as an IKDC 2000 score of 85% or greater and 85% or greater leg symmetry index on hop and strength tests. Researchers registered further knee surgery and reinjuries and patients completed another return to sport questionnaire at 2-year follow-up. To study the predictive ability of the test battery, researchers performed regression analyses and receiver operating characteristic analyses.
Results showed 42% of 103 patients who completed the 2-year follow-up returned to their preinjury level of sport. Researchers found return to sport was predicted by ACL-RSI 9 months score after surgery and age, with patients with an ACL-RSI of less than 47 at risk of not returning to sport. However, the functional tests did not predict return to sport, according to results. Researchers noted six patients sustained ACL reinjuries and seven patients underwent surgery for other knee complaints or injuries after return to sport testing. Of the 29 patients who passed all return to sport criteria and were cleared for return to sport, results showed no patients sustained a second knee injury.
“This study may have a future impact on orthopedics by contributing to the knowledge about what the different return to sport tests actually tells us. The importance of including psychological factors in the assessments is highlighted,” Faleide told Healio Orthopedics. “Further, the role of functional tests needs clarification: They do not seem to be informative on ability to return to sport, but are they informative about reinjury risk? It is a hope that this study will encourage a critical view on what tests we perform and how we interpret them when we advise our patients on return to sport.”
Perspective
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Success after ACL reconstruction is multifaceted and involves return to sport in a timely manner and without a secondary ACL injury. However, studies show that only 65% of patients return to a preinjury level of sport and the risk of a second ACL tear is as high as 30% in younger athletes. These concerning results necessitate optimization of rehabilitation and return to sport testing.
A variety of functional tests have been reported, but these are typically described in isolation rather than in combination, limiting the ability to measure their contribution to return to sport. This study examines both functional and psychological testing on return to sport and reinjury rates. Surprisingly, the study showed a gap between psychological and physical readiness, and, therefore, can help to guide future research. Quantitative functional tests do not reveal deficiencies in movement quality. Therefore, qualitative assessments should be incorporated in return to sport testing as well.
Return to sport is complex and requires both physical and psychological recovery. To optimize return to sport, a comprehensive approach should be utilized to include the physician, physical therapist, athletic trainer and coach. Using a series of milestones, testing should initially start with psychological responses (self-esteem, confidence, motivation and optimism) at the time of injury and then should progress to include qualitative and quantitative parameters in the return to sport process.
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