title: Variables associated with return to sport following anterior cruciate ligament reconstruction: a systematic review.
abstract: BACKGROUND
  As one of the purposes of anterior cruciate ligament reconstruction (ACLR) is to return athletes to their preinjury activity level, it is critical to understand variables influencing return to sport. Associations between return to sport and variables representing knee impairment, function and psychological status have not been well studied in athletes following ACLR.
  
  
  OBJECTIVE
  The purpose of this review was to summarise the literature reporting on variables proposed to be associated with return to sport following ACLR.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Medline, EMBASE, CINAHL and Cochrane databases were searched for articles published before November 2012. Articles included in this review met these criteria: (1) included patients with primary ACLR, (2) reported at least one knee impairment, function or psychological measure, (3) reported a return to sport measure and (4) analysed the relationship between the measure and return to sport.
  
  
  RESULTS
  Weak evidence existed in 16 articles suggesting variables associated with return to sport included higher quadriceps strength, less effusion, less pain, greater tibial rotation, higher Marx Activity score, higher athletic confidence, higher preoperative knee self-efficacy, lower kinesiophobia and higher preoperative self-motivation.
  
  
  CONCLUSIONS
  Weak evidence supports an association between knee impairment, functional and psychological variables and return to sport. Current return to sport guidelines should be updated to reflect all variables associated with return to sport. Utilising evidence-based return to sport guidelines following ACLR may ensure that athletes are physically and psychologically capable of sports participation, which may reduce reinjury rates and the need for subsequent surgery.
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine, , St Louis, Missouri, USA.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Czuppon
authors.forename: Brad A
authors.initials: BA
authors.lastname: Racette
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Klein
authors.forename: Marcie
authors.initials: M
authors.lastname: Harris-Hayes
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000534:rehabilitation*; D001265:Athletic Injuries / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation; D001294:Attitude to Health; D005239:Fear; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery; D008297:Male; D020127:Recovery of Function / Q000502:physiology
keywords: Knee ACL; Physiotherapy; Psychology; Sports rehabilitation programs