Introduction
Success and timing of return to sports (RTS) after anterior cruciate ligament (ACL) reconstruction (ACLR) depend on various factors. While many studies explore sport-specific outcomes and factors influencing RTS, limited literature focuses on martial arts. The study aims to assess ACLR outcomes and RTS characteristics in martial arts athletes. We hypothesized that those who successfully returned to martial arts will report higher patient reported outcomes (PROs).
Methods
A single-center cohort of patients who underwent ACLR by seven fellowship trained sports medicine surgeons and participated in martial arts prior to ACL injury were retrospectively reviewed. Exclusion criteria included age <14 years at surgery and <1 year follow-up. Long-term evaluation was conducted using a questionnaire assessing sports participation before and after injury, injury mechanism, return to martial arts, and re-injury. Demographic and surgical data were collected via chart review. The questionnaire included the International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner Activity Scale, and Visual Analogue Scale (VAS) pain scores. Patients were stratified into two groups depending on whether they returned to martial arts postoperatively. Statistical analyses included Chi square and Fisher’s exact tests for categorical variables, or Mann Whitney U tests and independent sample t-tests for nonparametric and parametric variables, respectively. Significance level was set at P<0.05.
Results
A total of 39 patients with a mean age of 30.6 ± 10.5 at surgery completed the questionnaire at a mean follow-up of 12.46 ± 8.2 years after ACLR. Leading types of martial arts were wrestling, taekwondo, mixed martial arts, and boxing (38%, 31%, 15%, 15%, respectively), with many participating in more than one type. Of the cohort, 82% (n=32) injured their ACL while performing martial arts, 78% (n=25) of whom sustained their injury while combating an opponent. The rate of successful return to martial arts was 74% (n=29), of which 79% (n=23) reported that they returned to their preinjury levels or higher. Most of those who RTS returned to training within 9 months after surgery (34%), and to competition level within 12 months after surgery (31%). The leading reason for not returning to MMA was fear of re-injury. A greater proportion of patients who successfully returned considered martial arts as their primary sport (90% vs 70%, p<0.05) and participated at a competitive level before their injury (76% vs 40%, p<0.05). A greater proportion of patients who did not return to martial arts had a re-injury to their knee (20% vs 17%, p<0.05) and underwent revision ACLR (20% vs 14%, p<0.05). There was no significant difference in IKDC and VAS scores at final follow-up. The difference in Tegner scores between the final follow-up and before injury was also similar between groups.
Conclusion
This study highlights that most martial arts athletes successfully RTS after ACLR, particularly those at a competitive level pre-injury. Fear of re-injury emerged as the major concern for athletes to return to martial arts, indicating a need to evaluate internal motivation and psychological readiness to tailor rehabilitation protocols to meet the needs of this unique patient population.