Importance of functional performance and psychological readiness for return to preinjury level of sports 1 year after ACL reconstruction in competitive athletes

Abstract

Purpose

This study aimed to identify independent predictive factors for return to sports (RTS) after anterior cruciate ligament (ACL) reconstruction in competitive-level athletes and to determine optimal cut-off values for these factors at 6 months after surgery.

Methods

A total of 124 competitive athletes (50 males and 74 females; mean age, 17.0 years; preinjury Tegner activity scale > 7) who underwent primary ACL reconstruction were enrolled. Assessments at 6 months after surgery consisted of knee functional tests [quadriceps index, hamstrings index, and single-leg hop for distance (SLH)] and 2 self-report questionnaires [IKDC subjective score and ACL-Return to Sport after Injury scale (ACL-RSI)]. At 1 year after surgery, athletes were classified into the RTS group (n = 101) or non-RTS group (n = 23) based on self-reported sports activities. After screening possible predictive factors of RTS, multivariate logistic regression and receiver operating characteristic curve analyses were performed to identify independent factors.

Results

Multivariate logistic regression analysis identified SLH (odds ratio, 2.861 per 10 unit increase; P < 0.001) and ACL-RSI (odds ratio, 1.810 per 10 unit increase; P = 0.001) at 6 months as independent predictors of RTS at 1 year after surgery. Optimal cut-off values of SLH and ACL-RSI were 81.3% (sensitivity = 0.891; specificity = 0.609) and 55 points (sensitivity = 0.693; specificity = 0.826), respectively.

Conclusion

In competitive athletes, SLH < 81% and ACL-RSI < 55 points at 6 months after surgery were associated with a greater risk of unsuccessful RTS at 1 year after surgery. SLH and ACL-RSI at 6 months could serve as screening tools to identify athletes who have difficulties with returning to sports after ACL reconstruction.

Level of evidence

III.

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Fig. 1
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Abbreviations

ACL:

Anterior cruciate ligament

ACL-RSI:

Anterior Cruciate Ligament-Return to Sport after Injury scale

AUC:

Area under the curve

BTB:

Bone–patellar tendon–bone

HI:

Hamstrings index

LSI:

Limb symmetry index

QI:

Quadriceps index

ROC:

Receiver operating characteristic

RTS:

Return to sports

SLH:

Single-leg hop for distance

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Correspondence to Takuya Kitaguchi.

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This study was approved by the Ethics Committee of Osaka Rosai Hospital (ID.29-21).

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Kitaguchi, T., Tanaka, Y., Takeshita, S. et al. Importance of functional performance and psychological readiness for return to preinjury level of sports 1 year after ACL reconstruction in competitive athletes. Knee Surg Sports Traumatol Arthrosc 28, 2203–2212 (2020). https://doi.org/10.1007/s00167-019-05774-y

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Keywords

  • Anterior cruciate ligament
  • Reconstruction
  • Return to sports
  • Predictive factor
  • Cut-off value