ISAKOS: 2023 Congress in Boston, MA USA

2023 ISAKOS Biennial Congress Paper


Return to Sport and Psychological Readiness to Return to Sport in Individuals who Have Undergone Bilateral vs Unilateral ACL Surgeries

Michael Buldo-Licciardi, BS, New York UNITED STATES
Jordan Eskenazi, BS, Boca Raton, Florida UNITED STATES
Zachary I Li, BA, New York UNITED STATES
Nicole Danielle Rynecki, MD, New York, NY UNITED STATES
Samuel Montgomery, MD, New York, New York UNITED STATES
Michael J Alaia, MD, New York, New York UNITED STATES
Eric Jason Strauss, MD
Laith M. Jazrawi, MD, New York, NY UNITED STATES
Kirk Anthony Campbell, MD, New York, NY UNITED STATES

NYU Langone Medical Center, New York, New York, UNITED STATES

FDA Status Not Applicable


Our study shows no significant differences in return to sport and psychological readiness to return to sport between individuals who underwent bilateral vs unilateral ACL surgeries.



To compare psychological readiness to return to sport (RTS) and RTS rates between patients undergoing bilateral versus unilateral anterior cruciate ligament reconstruction (ACLR).


A retrospective review of patients who underwent ACLR with a minimum 2-year follow-up was conducted. Bilateral ACLR were matched 1:3 to unilateral reconstructions based on age, sex, and body mass index (BMI). Psychological readiness to RTS was assessed using the validated ACL Return to Sport after Injury Scale (ACL-RSI). This along with time and level of RTS were compared between the two cohorts. Statistical analysis was conducted with chi-square for categorical variables and two-sided t-test for continuous variables.


One hundred seventy patients, 44 who underwent bilateral ACLR and 132 who underwent unilateral ACLR were included. At the time of first surgery, patients were 28.8 ± 9.4 years old in the unilateral cohort and 25.7 ± 9.8 years old in the bilateral cohort (p=0.06). Patients were equally comprised of males and females (50%). There was no difference in psychological readiness to RTS (bilateral: 50.5 vs unilateral 48.1, (p=0.66), RTS rates (unilateral: 78.0% vs bilateral: 65.9%, p=0.16), percentage of return to preinjury sport level (unilateral: 61.2% vs bilateral: 69.0%, p=0.21) or time to return (unilateral: 41.2 ± 29.3 weeks vs bilateral: 35.2 ± 23.7 weeks, p=0.31) between the two cohorts. Differences existed among patients within the bilateral ACLR cohort that were not found in the unilateral ACLR cohort: patients aged 30 and older had significantly lower ACL-RSI scores (age <30: 59.0 vs =30: 39.5, p=0.01), as did females (male: 60.2 vs female: 42.1, p=0.02).


Compared to patients who undergo unilateral ACL reconstructions, patients who undergo bilateral ACL reconstructions are equally as psychologically ready to return to sport, demonstrating equal rates of return to sport, time to return, and level of return.