Factors which influence return to sport folllowing anterior cruciate ligament (ACL) reconstruction surgery: A narrative review

Abstract

Objectives: To provide an evidence-based narrative review in accordance with the PRISMA guidelines of return to pre-injury sport levels following ACL reconstruction surgery. Data sources: Databases including: Pubmed, MEDLINE, Embase, CINAHL, Web of Science and Google Scholar were searched. Various combinations of the following keywords; 'ACL reconstruction', 'ACL surgery', 'sports', 'sports activity', and 'return to sports participation', were used in the searches. Study selection: Thirty-one studies were identified and included in this review. All studies documented a specific return to sport percentage after ACL reconstruction or reported a mean preoperative and postoperative activity score. Data extraction: Return-to-sport rates (RTS) following ACL reconstruction surgery and factors influencing these outcomes including: operative style, acute versus chronic ACL deficiency, prehabilitation/rehabilitation programmes, psychological factors, age/gender and competitive/elite athletes were compared between studies. Data synthesis: RTS ranged from 20% to 100% depending on the cohort and sporting discipline. There was no leading graft choice or surgical technique that provided better RTS, however early reconstruction and early-return to sports had superior outcomes than late reconstruction and late-return to sports. There was some evidence to suggest that psychological status six months postoperatively could be crucial in terms of RTS. Higher RTS were observed in males and younger patients while the majority of professional athletes returned to pre-injury levels despite abnormal knee function. Conclusion: Return to pre-injury levels of sport following ACL reconstruction is multifactorial. To establish accurate return to pre-injury sport rates, future studies need to document pre-injury activity levels in addition to preoperative activity levels.