Liana Balaghi Enda King Lindsay Tetreault Eanna Falvey


Introduction: Anterior cruciate ligament (ACL) tears are the most frequently reported knee injury in athletes. For those who wish to return to play (RTP), ACL reconstruction (ACLR) is recommended to restore knee function and stability. Knowledge of important predictors of RTP post-ACLR can aid surgeons and allied health professionals to effectively manage athletes’ rehabilitation expectations. The purpose of this study was to determine which athlete factors and patient reported outcomes predict RTP at 1-year post-ACLR.

Methods: This prospective cohort study recruited 336 participants who underwent ACLR at SSC in Dublin. Data collected included; baseline demographics, details of sport participation, injury mechanism, intent to RTP and patient-reported outcome measure (PROM) questionnaires at baseline (Marx, ACL-RSI) and at 1-year post-ACLR (Marx, ACL-RSI, Cincinnati, IKDC). Participants were categorised based on successful RTP 1-year post-ACLR. Univariate and multivariate logistic regression analysis were used to evaluate the association between RTP and athlete factors and PROMs.

Results: Two hundred twenty (65.45%) participants RTP at 1-year post-ACLR. Participants were more likely to RTP if they were younger (OR:0.972, 95%CI:0.952-0.995), intended to return to a higher level of sport (OR:2.125, 95%CI:1.169-3.861), had higher baseline Marx scores (OR: 1.066, 95%CI:1.022-1.111), and higher Marx (OR:1.291, 95%CI:1.214-1.373) and IKDC scores at 1-year post-operative (OR:1.065, 95%CI:1.041-1.088). Higher Marx scores at 1-year post-operative (OR:1.291, 95%CI:1.214-1.373) were the only significant predictors of RTP. The model yielded an area under the curve of 0.81, demonstrating excellent discriminative ability.

Discussion: Patients were more likely to RTP if they had better functional activity outcomes at 1-year post-ACLR, suggesting that PROMs can be used to assess how likely an athlete is to RTP.

Conclusion: Further research should focus on identifying which PROMs are modifiable and can be improved during post-ACLR rehabilitation to further encourage RTP.

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Primary Research