Patient characteristics
| Return to sport rate (%) | Variables associated with return to sport | Variables not associated with return to sport | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Literature | Level of evidence57/ risk of bias55 | Total patients | Mean age (years) | Graft type | Preinjury athletic participation | Patient follow-up | Preinjury level | Modified level | Did not return | Knee impairment or functional | Psychological | Knee impairment or functional | Psychological |
| Overall | 1574 (67% M/33% F) | 27.3* | 378 PT/867 HS/329 NR† | 50.7 | 32.9 | 17.2 | |||||||
| Ardern et al58 | 4/high | 503 (68% M/32% F) | 27.2 | 503 HS | Competitive | 1 year | 33.4 | 33.6 | 33.0 | LSI ≥85% hop tests | – | IKDC grade | – |
| Arvidsson et al59 | 4/high | 87 (97% M/3% F) | 25.3 | 87 PT | NR | 7.9 years | 25.3 | 66.7 | 8.0 | Higher quadriceps torque | – | Hamstring torque | – |
| Baltaci61 | 4/high | 15 (gender NR) | 29.6 | NR | Recreational | 1.5–2 years | NR | NR | NR | Faster 6 m shuttle run test, higher hamstring torque | – | LSI on hop tests, Lysholm Knee Score, step-hop test, vertical jump, 10-step climb test | – |
| Barrett and Mackenney60 | 4/high | 45 (73% M/27% F) | 26.4 | 45 PT | Competitive and recreational | 3 years | 53.3 | 31.1 | 15.6 | Lower knee effusion and pain | – | Anterior knee laxity | – |
| Gobbi et al63 | 2/high | 60 (67% M/33% F) | 30.4* | 60 HS | At least recreational | 1–3 years | 100 | 0 | 0 | – | Higher preoperative psychovitality | – | – |
| Gobbi and Francisco62 | 4/high | 100 (67% M/33% F) | 28 | 50 PT/50 HS | At least recreational | 2 years | 65.0 | 24.0 | 11.0 | Higher Marx Activity Score | Higher preoperative psychovitality | Lysholm Knee Score, IKDC subjective form score, IKDC grade | – |
| Heijne et al64 | 2/high | 64 (55% M/45% F) | 30.1 | 32 PT/32 HS | NR | 1 year | NR | NR | NR | Higher preoperative quadriceps torque | – | Preoperative knee extension ROM, preoperative anterior knee laxity, preinjury sports activity level | – |
| Kvist et al48 | 4/high | 62 (55% M/45% F) | 27 | 55 PT/7 HS | NR | 3–4 years | 53.0 | NR | NR | – | Lower TSK score | – | – |
| Langford et al68 | 4/high | 87 (63% M/37% F) | 27.5 | 4 PT/83 HS | Competitive | 6 months; 1 year | 51.0 | NR | NR | – | Higher ACL-RSI | LSI on hop tests, postoperative anterior knee laxity | ERAIQ |
| Lee et al6 | 4/high | 64 (95% M/5% F) | 24.8 | 64 HS | Competitive and recreational | 5 years | 43.8 | 26.5 | 29.7 | Higher Lysholm Knee Score, higher IKDC subjective form score, IKDC Grade A and B | – | – | – |
| Lee S et al67 | 2/high | 42 (88% M/12% F) | 30.3* | 42 HS | NR | 2 years | NR | NR | NR | Higher postoperative tibial IR, ER, and total rotation at 0° of knee extension | – | – | – |
| Lentz et al69 | 2/high | 94 (64% M/36% F) | 22.4 | PT and HS | At least recreational | 1 year | 55.0 | NR | NR | Lower knee effusion, fewer episodes of instability, lower pain, higher quadriceps torque-body weight ratio, higher IKDC subjective form score | Lower TSK score | Postoperative anterior knee laxity, postoperative knee extension and flexion ROM, LSI quadriceps strength | – |
| Mikkelsen et al70 | 4/high | 44 (77% M/23% F) | 24.1* | 44 PT | Recreational (1 no participation) | 2.5 years | 38.6 | 52.3 | 9.1 | Higher quadriceps torque | – | – | – |
| Thomee et al49 | 2/high | 38 (66% M/34% F) | 29.7 | 12 PT /26 HS | At least recreational | 1 year | NR | NR | NR | – | Higher preoperative K-SES | – | – |
| Tripp et al65 | 2/high | 49 (55% M/45% F) | 29.2 | 49 PT | At least recreational | 1 year | NR | NR | NR | – | Lower TSK score | – | Negative affect, catastrophising |
| Webster et al66 | 2/high | 220 (56% M/44% F) | 29.2 | NR | At least recreational | 1 year | 39.5 | 29.1 | 31.4 | – | Higher ACL-RSI | – | – |
*Weighted mean age.
†The overall ‘NR’ in the graft type column includes the 94 patients in the Lentz et al68 study, as specific numbers for patients with each graft type were not provided.
Return to preinjury sport defined as patients achieving the same activity level or same sport postsurgery as their preinjury activity level. Modified sports activity defined as patients achieving a lesser activity level as compared with their preinjury activity level. No return to sport defined as patients unable to participate in any athletic activity.
ACL-RSI, anterior cruciate ligament-return to sport after injury scale; CKC, closed kinetic chain; ER, external rotation; ERAIQ, Emotional Responses of Athletes to Injury Questionnaire; F, female; HS, hamstring tendon; IKDC, International Knee Documentation Committee; IR, internal rotation; K-SES, Knee Self Efficacy Scale; LSI, limb symmetry index; M, male; NR, not reported; OKC, open kinetic chain; PT, patellar tendon; ROM, range of motion; TSK, Tampa Scale of Kinesiophobia.