Return To Sport After Primary Anterior Cruciate Ligament Reconstruction In Sweden: A longitudinal registry-based cohort study of 511 patients from the SPARX cohort

Return To Sport After Primary Anterior Cruciate Ligament Reconstruction In Sweden: A longitudinal registry-based cohort study of 511 patients from the SPARX cohort

Daniel Castellanos Dolk, MD, SWEDEN Per Wretenberg, MD,PhD, Prof., SWEDEN Anders Stalman, MD, PhD, Associate Professor, SWEDEN Joanna Kvist, Professor, SWEDEN

Karolinska Institutet, Stockholm, Stockholm, SWEDEN


2025 Congress   ePoster Presentation   2025 Congress   Not yet rated

 

Anatomic Location

Anatomic Structure

Treatment / Technique

Ligaments

ACL

Diagnosis / Condition


Summary: Return to sport following anterior cruciate ligament reconstruction is influenced by patient sex, age, pre-injury sporting level, surgical timing, and especially psychological readiness, with only three out of five athletes resuming knee-demanding sports and just half regaining their pre-injury performance level.


Introduction

Anterior cruciate ligament (ACL) injuries are a common and significant concern for athletes, especially those participating in sports that place a high demand on the knees. ACL reconstruction (ACL-R) aims to restore knee stability and function, yet returning to pre-injury levels of sports participation remains a challenging goal. The SPARX (Sports and Physical Activity after Reconstruction of the Anterior Cruciate X Ligament) study was designed to assess the return to sport (RTS) in individuals undergoing primary ACL-R registered in the Swedish National Knee Ligament Registry (SNKLR) with prior participation in Tegner Activity Scale (TAS) ≥7.

Methods

This longitudinal, prospective, national registry-based cohort study included patients aged 16-40 years who underwent primary ACL-R registered in the SNKLR and had a pre-injury Tegner score of ≥7 during the study period of December 2019 to May 2021. Participants were followed for 24 months post-surgery, with data collected through monthly web-based surveys as well as from the SNKLR. These surveys assessed rehabilitation participation, sports involvement, knee function, and new injuries. Primary outcomes were time and return-to-sport (RTS) rates to TAS ≥7. Secondary outcomes were time and RTS to same/higher level and analysis of predictive factors for RTS analyzed using cox regression.

Results

A total of 511 participants with a pre-injury TAS score of ≥7 were included. While 62% (n=315) achieved RTS with an average time to RTS of 12.3 months (SD 4.7), only half (51%) achieved RTS to the same/higher level of activity after ACL-R within 24 months with a mean time of 12.7 months (SD 4.9). Multivariable cox regression analysis showed that females had a lower chance of achieving RTS (HR 0.71; 95% CI 0.56-0.90). Several other predictors, such as age, sporting level, timing of surgery and meniscal injuries were found to be important. ACL-Return to Sports after Injury (ACL-RSI) >4.2 at 3 months had a positive impact on TAS ≥7 (HR 1.61; 95% CI 1.26-2.07; p < 0.001) and to same /higher level (HR 1.70; 95% CI 1.28-2.25; p < 0.001).

Conclusion

Overall, 62% of patients undergoing ACL-R returned to knee-demanding sports (TAS≥7) with an average time to RTS of 12.3 months. Important predictors such as sex, age, sporting level, timing of surgery and meniscus injury were observed. Psychological readiness at 3 months seams to play a crucial role in successful RTS and is potentially modifiable.