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Return to sport after Anterior Cruciate Ligament (ACL) reconstruction

A recent systematic review of return to sport following anterior cruciate ligament (ACL) reconstruction surgery has recently been published…

Sixty-nine articles were reviewed, investigating 7556 patients

The review showed that following ACL reconstruction

  •  81% of people returned to sport (any sport)
  •  65% returned to their preinjury level of sport
  •  55% returned to competitive sport after surgery.

Younger age, male gender, playing elite sport and having a positive psychological outlook  favoured returning to the preinjury level sport.

The review classified return to sport at three different levels –  returning to any sport, to the preinjury level sport and competitive level sport. It is important to consider that after surgery some athletes may change sports. Some may make a positive decision to return at a lower level. This does not mean that the sportsperson is unhappy with the result of their surgery.

Determining  success in returning to sport should be individualised according to the goals of the patient.

Elite athletes may have invested greater time  in sport through playing and longer training hours. They may derive financial benefit from playing sport either as a professional player or as a sport scholarship holder. Elite players may also have access to intensive and highly structured support from medical and rehabilitation professionals that is not available to non-elite athletes. This may explain why elite athletes had twice the odds of returning to their preinjury level of sport, and six times the odds of returning to competitive sport as non-elite athletes.

Younger athletes are also more likely to return to their preinjury level sport. Younger athletes may have fewer family or employment commitments allowing them more time to rehabilitate and then participate in sport. Sport may also represent the major social outlet for younger athletes which may be a positive motivational factor  for returning to sport.

Most of the factors that impacted on returning to sport in the review could not be changed (age, gender) . Improved rates of return to their preinjury level of sport were seen in people with a positive  psychological outlook . This is particularly important because psychological factors may be modifiable with appropriate interventions..

Correctly performed surgery is important, but correct rehabilitation (physiotherapy) addressing both the physical and psychological aspects of a patients care is also vital.