Reasons for Not Returning to Pre-injury Sport Level After ACL-Reconstruction

The study aimed to identify athlete-reported reasons for not returning to pre-injury sports level after anterior cruciate ligament reconstruction (ACLR) and to identify the factors associated with these reasons. Ninety-one athletes with 2 years post-ACLR indicated whether or not they had returned to their pre-injury sport level (same frequency, duration, and intensity). Athletes who did not return were asked to provide the reasons. Athletes' characteristics and injury-related factors were used to determine factors associated with the reasons for not returning. Only nine athletes (10%) returned to pre-injury sport level after ACLR. The most common reasons for not returning were lack of confidence or concerns about re-injury (48.8%), followed by continued post-surgical impairments in the reconstructed knee (39%). Having episodes of the knee giving way after ACLR was the only significant predictor of post-surgical impairments (48.8%; OR=8.3, 95%CI=2.48-27.42, p=0.001). Lack of confidence, concerns about re-injury, or post-surgical impairments in the reconstructed knee were the most frequently reported reasons for not returning to pre-injury sports level with 2 years post-ACLR. Reported dynamic knee instability was the only factor associated with ongoing post-surgical knee impairments after ACLR. Rehabilitation programs should address athletes' psychological responses and resolve knee impairments to optimize return to pre-injury sport level after ACLR.