Return to Sport Guidelines Following Total Knee Arthroplasty: A Scoping Review

Purpose: Our scoping review aimed to explore available evidence on health care providers' recommendations for return to sport (RTS) after total knee arthroplasty (TKA), particularly in the context of increasing demand among younger patients to restore function, enhance quality of life, and resume sports participation. Method: We searched MEDLINE, CINAHL, Embase, Scopus, and SPORTDiscus for diverse study designs, published between January 1, 1990, and March 30, 2023, that focused on health care provider recommendations for RTS following TKA. Studies were screened through a title/abstract review, followed by a full-text review. The Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was used to evaluate the methodological quality. We synthesized recommendations with a narrative review. Results: Altogether, 23 articles were included for evaluation. Most studies (12) were evaluated as low quality (score < 25%), while remaining studies (11) were rated as moderate quality (score 25%-75%). Recommendations indicated a return to low-to-moderate impact and avoidance of high-impact sports. Concerns for implant survivorship and patient-related factors strongly influenced recommendations. Conclusion: While low-to-moderate impact is recommended, a clear understanding of what defines level of impact and the sports included in each category are not well established and should be explored to offer consistent guidelines.