Introduction Intention of returning to level-I sports (handball, soccer, basketball and floorball) is one of the main reasons for choosing anterior cruciate ligament reconstruction (ACLR). Our aim was to assess participation in level-I sports at one, two and five years postoperatively in those who choose ACLR to enable return to level-I sport. A secondary aim was to assess the relationship between participation in level-I sports and self-reported knee function.

Materials and methods Sixty patients who all stated they chose ACLR to return to level-I sport (55% women, median age 23 years [min-max: 14–39]) were included in a prospective cohort study. Participants had no major concomitant injuries and participated in nonprofessional competitive level-I sports ≥2 times/week prior to injury. Sports participation and International Knee Documentation Committee Subjective Knee Form (IKDC 2000)-scores was recorded one, two and five years postoperatively.

Results At one, two and five years after ACLR, 29/58 (50% [95% CI: 36% to 64%]), 30/55 (55%[95% CI: 41% to 68%]) and 15/55 (27% [95% CI: 15% to 39%]) participated in level-I sports, respectively (follow-up rate: 92%–97%). Among those who participated at one year, 7/24 (29%) had quit after two years. Six of 48 (13%) participated at all three follow-ups. Participation in level-I sports was associated with higher IKDC 2000-scores one (b=11.9; 95% CI: 4.4 to 19.3) and two years (b=9.9; 95% CI: 2.3 to 17.4) postoperatively.

Conclusion Patients considering undergoing ACLR to enable return to level-I sports should be informed of the modest likelihood of returning one to five years postoperatively. Very few sustain participation from one to five years. Participation in level-I sports is associated with better self-reported knee function.