title: Factors associated with returning to football after anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  The aim of the present investigation was to identify possible factors associated with returning to football on an average 3.2 ± 1.4 years after anterior cruciate ligament (ACL) reconstruction in both male and female football players.
  
  
  METHODS
  The players were recruited from a patient database of football players that have undergone an ACL reconstruction between 2004 and 2007 at the Capio Artro Clinic, Sophiahemmet in Stockholm, Sweden. Special attention was paid to gender, age, type of graft for ACL reconstruction, associated injuries, anterior knee laxity, thigh muscle torques and symptoms/problems during, and/or after physical activity. In the beginning of the summer of 2009, 205 players (37.9 %) out of 541 players filled out a questionnaire designed to evaluate physical activity and knee function in a sports-specific setting. A detailed dropout analysis showed that females responded to a higher degree than males. No other significant differences between responders and non-responders were found.
  
  
  RESULTS
  Fifty-four per cent (n = 111) had returned to football, and 46 % (n = 94) had not. Using logistic regression analyses, we found that the female gender (p = 0.036, OR 0.518), cartilage injury (p = 0.013, OR 0.368), and pain during physical activity (p = 0.002, OR 0.619) were significant negative predictors for returning to football after ACL reconstruction and rehabilitation. For players with all three significant factors, only 10 % returned to football compared to 76.5 % of those without any of these factors.
  
  
  CONCLUSIONS
  Female gender, cartilage injury, and knee pain during physical activity were independent negative predictors for returning to football after ACL reconstruction. At a mean follow-up of 3.2 ± 1.4 years after ACL reconstruction, pain during physical activity was reported to be the most common symptom/problem in football players. The clinical relevance of this study is to improve the treatment of ACL injured football players focusing on female gender and knee pain. Furthermore, ACL injury prevention should be highlighted in football players, especially female players.
authors.affiliation: Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Sophiahemmet, Valhallavägen 91, 114 86, Stockholm, Sweden, alexander.sandon@capio.se.
authors.forename: Alexander
authors.initials: A
authors.lastname: Sandon
authors.forename: Suzanne
authors.initials: S
authors.lastname: Werner
authors.forename: Magnus
authors.initials: M
authors.lastname: Forssblad
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D020127:Recovery of Function; D000068958:Return to Sport; D012916:Soccer / Q000293:injuries*; D011795:Surveys and Questionnaires; D013548:Sweden; D016896:Treatment Outcome; D055815:Young Adult