Is Return-To-Sport A Measure of Success Following ACL Surgery

If athletes decide to have reconstructive knee surgery for a deficient anterior cruciate ligament (ACL), then is return-to-sport a measure of success for that surgery? Short-term (12 month) studies show that most people have not returned to their preinjury level of sports play following reconstructive surgery for a torn ACL. That's why the authors of this study extended the timeline to look at medium-term results.

They surveyed 314 athletes of all ages two to seven years after their ACL surgery. Athletes who filled out the self-report questionnaire answered questions about their level of sports participation before the injury and after the surgery. They also commented on overall knee function.

Almost everyone (93 per cent) tried to participate in their sport after their surgery. Only about half of them were successful. And only one-third were playing competitively. Athletes who returned to sports at their preinjury level by the end of the first year didn't always stay in their sport competitively. That told the researchers that short-term results (12 months after surgery) aren't always an accurate reflection of what will happen months to years later.

They noticed that men were more likely than women to get back into the game in that first year. But the final mid-term outcomes weren't any different between men and women. This could mean that women may take longer to rehab and recover but in the end, the results are the same as for men.

In any case, if someone does not return to full participation in their sport at a preinjury level after ACL surgery in the first year, this does not mean they won't ever get back their full function later. And that is an important finding physicians, Physical Therapists, and sports trainers can offer athletes who still have not regained full strength, function, and ability by the end of a year.

What keeps people from getting back into the game sooner than later? Why do some athletes stop playing and competing altogether after ACL reconstructive surgery? The hope of the researchers who conducted this study was to find some answers to these questions.

Some things to know about this group of patients: they all had surgery with the same surgeon using the same surgical technique. And they all followed the same post-operative rehab program with a Physical Therapist. Variables that differed from patient to patient included age, lifestyle factors, and exposure to sports opportunities.

Analysis of the data collected included these factors because the researchers thought perhaps younger patients were more likely to be involved in school sports. They would therefore have more opportunities for sports participation. Older patients might be prevented from getting back into play because of family or work. And as it turned out, more patients 25 years old and older were, in fact, not playing anymore compared with the younger (less than 25 years of age) athletes.

That brings us back to the original question: is return-to-sport a reasonable measure of ACL surgery success? The answer to that question is more of a maybe yes/maybe no than a definite yes or a definite no. This study provided evidence that failure to regain preinjury sports ability is directly linked with the function of the operative leg. Other personal factors also played an important role in the decision to return-to-sport.

Reference: Clare L. Ardern, BPhysio(Hons), et al. Return-to-Sport Outcomes 2 to 7 years After Anterior Cruciate Ligament Reconstruction Surgery. In The American Journal of Sports Medicine. January 2012. Vol. 40. No. 1. Pp. 41-48.

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