title: Sports participation 2 years after anterior cruciate ligament reconstruction in athletes who had not returned to sport at 1 year: a prospective follow-up of physical function and psychological factors in 122 athletes.
abstract: BACKGROUND
  A return to their preinjury level of sport is frequently expected within 1 year after anterior cruciate ligament (ACL) reconstruction, yet up to two-thirds of athletes may not have achieved this milestone. The subsequent sports participation outcomes of athletes who have not returned to their preinjury level sport by 1 year after surgery have not previously been investigated.
  
  
  OBJECTIVE
  To investigate return-to-sport rates at 2 years after surgery in athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  A consecutive cohort of competitive- and recreational-level athletes was recruited prospectively before undergoing ACL reconstruction at a private orthopaedic clinic. Participants were followed up at 1 and 2 years after surgery with a sports activity questionnaire that collected information regarding returning to sport, sports participation, and psychological responses. An independent physical therapist evaluated physical function at 1 year using hop tests and the International Knee Documentation Committee knee examination form and subjective knee evaluation.
  
  
  RESULTS
  A group of 122 competitive- and recreational-level athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction participated. Ninety-one percent of the athletes returned to some form of sport after surgery. At 2 years after surgery, 66% were playing sport, with 41% playing their preinjury level of sport and 25% playing a lower level of sport. Having a previous ACL reconstruction to either knee, poorer hop-test symmetry and subjective knee function, and more negative psychological responses were associated with not playing the preinjury level sport at 2 years.
  
  
  CONCLUSIONS
  Most athletes who were not playing sport at 1 year had returned to some form of sport within 2 years after ACL reconstruction, which may suggest that athletes can take longer than the clinically expected time of 1 year to return to sport. However, only 2 of every 5 athletes were playing their preinjury level of sport at 2 years after surgery. When the results of the current study were combined with the results of athletes who had returned to sport at 1 year, the overall rate of return to the preinjury level sport at 2 years was 60%. Demographics, physical function, and psychological factors were related to playing the preinjury level sport at 2 years after surgery, supporting the notion that returning to sport after surgery is multifactorial.
authors.affiliation: School of Allied Health, La Trobe University, Melbourne, Australia Division of Physiotherapy, Linköping University, Linköping, Sweden c.ardern@latrobe.edu.au.
authors.forename: Clare L
authors.initials: CL
authors.lastname: Ardern
authors.affiliation: School of Allied Health, La Trobe University, Melbourne, Australia.
authors.forename: Nicholas F
authors.initials: NF
authors.lastname: Taylor
authors.affiliation: School of Allied Health, La Trobe University, Melbourne, Australia OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia.
authors.forename: Julian A
authors.initials: JA
authors.lastname: Feller
authors.affiliation: OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Whitehead
authors.affiliation: School of Allied Health, La Trobe University, Melbourne, Australia.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Webster
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction; D056352:Athletes / Q000523:psychology*; D001265:Athletic Injuries / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000502:physiology / Q000601:surgery; D008297:Male; D011446:Prospective Studies; D020127:Recovery of Function; D013177:Sports / Q000523:psychology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: ACL; anterior cruciate ligament; orthopaedic; psychology; return to sport; sport