Return to sport assessment following isolated anterior cruciate ligament reconstruction - 82 consecutive cases

The purpose of this study was to investigate different patient related factors associa/copted with objective return to sport (RTS) testing after an isolated anterior cruciate ligament reconstruction (ACLR) following an optimised and standardized outpatient clinic setting.

From 2015 to 2019, patients with isolated ACL tears undergoing ACL reconstruction (ACLR) with hamstring autograft were included. All followed the same standardized rehabilitation protocol. RTS testing comprised isokinetic extensor (ISO Ext) and flexor (ISO Flex) strength, One-Leg Hop (OLH), Side Hop (SH), and Tapping Agility (TT). A Limb Symmetry Index (LSI) ≥ 90% defined the pass criterion for strength and hop tests; H/Q ≥ 50% was used for both limbs. Logistic regression assessed the influence of time after surgery, in-house vs. external rehabilitation and active/passive rehabilitation sessions on RTS pass rates (α=0.05).

Of 104 patients, 82 (45 male, 37 female; mean age 34 ± 11.2 years) completed RTS testing at 27.6 (±4.2) weeks after surgery. Patients completed 30 ± 16 strength and functional training sessions. Mean LSI was 92.8 (±11.1%) for OLH and 88.8 (±16.9%) for SH; mean H/Q was 53.9 (±10.8%) (affected) and 50.2 (±6.8%) (unaffected). Pass rates were 66.7% (OLH), 64.4% (SH), 32.4% (TT), 37.2% (ISO Ext), and 44.2% (ISO Flex). No consistent influencing factors were identified (p > 0.05). Fewer active physiotherapy sessions were associated with higher pass rates for SH (OR 0.934; p = 0.041) and OLH (OR 0.906; p = 0.034).

Less than half of patients met the commonly used RTS criteria at 6.5 months after ACLR, even after isolated ACL injury treated by a single surgeon using a standardized surgical technique and standardized rehabilitation protocol. These findings argue against time-based RTS clearance and support continued criterion-based rehabilitation and RTS testing.