Summary
The majority of patients undergoing ACL reconstruction return to sport, however the rate of return varies with different patient demographics and may be influenced by graft choice.
Abstract
Introduction
Return to sport is one of the most important outcome measures after anterior cruciate ligament (ACL) reconstruction. However, there is a lack of large cohort data which has resulted in significant variation in the reported rates of return to sport, as well as a lack of understanding on the patient and surgical factors that may influence return. The aim of this study was to analyze return to sport rates in a nationwide registry of patients who have undergone ACL reconstruction.
Methods
A patient questionnaire was sent to patients recorded in the New Zealand ACL Registry who underwent ACL reconstruction between 2017 and 2022. All patients had a minimum follow-up of two years in the Registry. This questionnaire asked patients whether they had returned to any level of sport following surgery. Patient demographic and intraoperative surgical data was extracted from the Registry for those who responded to the questionnaire. Return to sport rates were compared via univariate Chi-square test. Independent predictors of return to sport were identified through multivariable binary logistic regression to compute adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).
Results
A total of 2870 patients were analyzed, of which 68.6% of patients reported that they had returned to sport following their surgery (n = 1968), while 18.6% reported they had not returned (n = 535). There were 367 patients who reported that they did not undergo ACL reconstruction with the intention to return to sport. Excluding these patients improved the rate of return to sport to 78.6%. On multivariable analysis, a greater odds of return to sport was reported by male patients (aOR = 1.6, p<0.001), younger patients (aOR = 2.0, p<0.001 in age ≤20 years, aOR = 1.6, p<0.001 in age 21-30 years) and those who underwent earlier surgery (aOR = 1.3, p = 0.005). Return to sport was lower in patients with a grade 3 or 4 chondral injury (aOR = 0.7, p = 0.03) and in patients with a medial meniscal tear that was resected rather than repaired (aOR = 0.7, p = 0.04). When compared to the hamstring tendon autograft, a greater odds of return to sport was found in patients with a patellar tendon autograft (aOR = 1.3, p = 0.03).
Discussion And Conclusion
Most patients who underwent ACL reconstruction returned to sport. Gender, age, timing of surgery, meniscal treatment and chondral injury influenced return to sport rates. Patients with a patellar tendon autograft had a greater odds of return to sport when compared to patients with a hamstring tendon autograft.