Summary

Loss of interest and a busy work/family schedule in addition to the fear of re-injury are the main reasons for patients failing to return to pre-injury pivoting sports after Anterior Cruciate Ligament Reconstruction.

Abstract

Introduction

It is widely known that return to sports, in particular pivoting sports, after Anterior Cruciate Ligament (ACL) injury and Anterior Cruciate Ligament Reconstruction (ACLR) is disappointingly low. Patients often undergo ACLR with the intention of returning to their pre-injury activity level, however current research demonstrates many patients do not. We seek to assess the rate of return to pivoting sports 2 years after ACLR, and importantly analyse the reasons why patients do not achieve their initial goal.

Methods

A total of 276 patients undergoing primary ACLR with a hamstring (n=223) or quadriceps (n=53) autograft between June 2015 and June 2022, with or without concomitant meniscal repair, were prospectively recruited into an institutional research program. Surgery was undertaken by one of three orthopedic surgeons operating in private practice (RR, PD, PA). The group was heterogeneous with respect to the mechanism of injury, including: netball (n=56), Australian Rules Football (n=54), soccer (n=49), basketball (n=27), rugby (n=18), skiing (n=9), hockey (n=9), fighting contact sports (n=6), racquet sports (n=3), during another sporting or recreational activity (n=32), or as a result of a home- or work-based incident (n=12), or from a motor vehicle accident (n=1).

Results

Of the 276 patients, 232 were actively participating in pivoting sports at the time of their injury, of which 60.3% (140/232) had returned to their primary pre-injury pivoting sport by 2 years. Of these, 70.0% (98/140) felt they were performing at (or beyond) their pre-injury status, with 30.0% (42/140) stating that their performance was below pre-injury status for reasons that generally included feeling slower and/or less explosive running in straight lines and/or with change of direction, or still lacking sport-specific fitness and conditioning that subsequently affected their performance level.

Overall, 136 patients (49.3%) had not returned to their primary pre-injury pivoting sport within 2 years, of which 92 were actively participating in pivoting sports at the time of their injury. The primary reasons stated for not returning included losing interest in their primary pre-injury pivoting sport and no longer seeking to return (21.7%), being too busy to train, play or commit to their chosen sport due to a busy work and/or family environment (22.8%), or reasons associated with fear of re-injury or lacking confidence in the knee (17.4%). Other less reported reasons included ongoing knee issues (6.5%) or not feeling physically ready (5.4%), while 6 female patients (6.5%) had fallen pregnant within 2 years of surgery.

Conclusions

This study confirms the multi-factorial nature of the reasons for patients failing to return to their pre-injury activity level after ACL injury and then reconstructive treatment. Maintaining motivation and reducing barriers to participating in pivoting sports are important considerations in discussing return to sports for community level athletes, in addition to the well-recognised issues relating to the knee itself and fear of re-injury.