title: An Ecological Study of Anterior Cruciate Ligament Reconstruction, Part 1: Clinical Tests Do Not Correlate With Return-to-Sport Outcomes.
abstract: BACKGROUND
  Additional high-quality prospective studies are needed to better define the objective criteria used in relation to return-to-sport decisions after synthetic (ligament advanced reinforcement system [LARS]) and autograft (hamstring tendon [2ST/2GR]) anterior cruciate ligament (ACL) reconstruction in active populations.
  
  
  OBJECTIVE
  To prospectively investigate and describe the recovery of objective clinical outcomes after autograft (2ST/2GR) and synthetic (LARS) ACL reconstructions, as well as to investigate the relationship between these clinimetric test outcomes and return-to-sport activity (Tegner activity scale [TAS] score) at 12 and 24 months postoperatively.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  A total of 64 patients who underwent ACL reconstruction (32 LARS, 32 2ST/2GR autograft) and 32 healthy reference participants were assessed for joint laxity (KT-1000 arthrometer), clinical outcome (2000 International Knee Documentation Committee [IKDC] knee examination), and activity (TAS score) preoperatively and at 12, 16, 20, and 24 weeks and 12 and 24 months postoperatively.
  
  
  RESULTS
  There was no significant correlation observed between clinical results using the 2000 IKDC knee examination and TAS score at 24 months (rs= 0.188,P= .137), nor were results for side-to-side difference (rs= 0.030,P= .814) or absolute KT-1000 arthrometer laxity of the surgical leg at 24 months postoperatively (rs= 0.076,P= .553) correlated with return-to-sport activity. Nonetheless, return-to-sport rates within the surgical cohort were 81% at 12 months and 83% at 24 months, respectively. No statistically significant differences were observed between physiological laxity of the uninjured knee within the surgical group compared with healthy knees within the reference group (P= .522).
  
  
  CONCLUSIONS
  The results indicate that although relatively high levels of return-to-sport outcomes were achieved at 24 months compared with those previously reported in the literature, correlations between objective clinical tests and return-to-sport outcomes may not occur. Clinical outcome measures may provide suitable baseline information; however, the results of this study suggest that clinicians may need to place greater emphasis on other outcome measures when seeking to objectively promote safe return to sport.
authors.affiliation: Research Institute for Sport and Exercise, University of Canberra, Bruce, Australia.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: McGrath
authors.affiliation: Research Institute for Sport and Exercise, University of Canberra, Bruce, Australia.
authors.forename: Gordon
authors.initials: G
authors.lastname: Waddington
authors.affiliation: Research Institute for Sport and Exercise, University of Canberra, Bruce, Australia.
authors.forename: Jennie M
authors.initials: JM
authors.lastname: Scarvell
authors.affiliation: Research Institute for Sport and Exercise, University of Canberra, Bruce, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Ball
authors.affiliation: Private practice, Deakin, Australia.
authors.forename: Rob
authors.initials: R
authors.lastname: Creer
authors.affiliation: Canberra Orthopaedics, Deakin, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Woods
authors.affiliation: Orthopaedics ACT, Woden, Australia.
authors.forename: Damian
authors.initials: D
authors.lastname: Smith
authors.affiliation: Research Institute for Sport and Exercise, University of Canberra, Bruce, Australia.
authors.forename: Roger
authors.initials: R
authors.lastname: Adams
keywords: ACL; LARS; autograft; hamstring; knee