Variables associated with return to sport
| Strong evidence54 for association with return to sport | None | |
| Moderate evidence54 for association with return to sport | None | |
| Weak evidence54 for association with return to sport | Pain | At 1-year postsurgery, patients returning to preinjury level of sport reported less pain than those who did not return to sport (0.4 vs 1 on visual numeric pain scale where 0=no pain, 10=worst pain possible, p=0.05)69 |
| At 3 years postsurgery, five of six patients with effusion and pain had decreased sports participation level60 | ||
| Postoperative quadriceps torque | At 1-year postsurgery, higher quadriceps torque-body weight ratio for patients returning to preinjury level of sport than those who did not return to sport (81.5% vs 73.9%, p=0.05)69 | |
| At 5 years postsurgery, mean concentric quadriceps torque difference between surgical limb and non-surgical limb lower in OKC+CKC group than CKC group at 30o/sec (34 vs 60 Nm, p<0.01), 120o/sec (28 vs 39 Nm, p<0.05), 240o/sec (18 vs 27 Nm, p<0.07). Mean eccentric quadriceps torque difference between surgical limb and non-surgical limb lower in OKC+CKC group than CKC group at 30o/sec (32 vs 76 Nm, p<0.001), 120o/sec (40 vs 65 Nm, p<0.01), and 240o/sec (38 vs 60 Nm, p<0.02). 54.5% of OKC+CKC group returned to sport versus 22.7% of CKC group70 | ||
| At mean 7.9 years postsurgery, difference in peak quadriceps torque between surgical leg and non-surgical leg not different in group with return to preinjury level of sport (205 vs 226 Nm, p<0.05) but different in group participating in only non-cutting sports (200 vs 241 Nm, p<0.01)59 | ||
| Knee effusion | At 1-year postsurgery, less effusion for patients returning to preinjury level of sport than those who did not return to sport69 | |
| At 3 years postsurgery, five of six patients with effusion and pain had decreased sports participation level60 | ||
| Postoperative tibial rotation range of motion | At 2 years postsurgery, higher Tegner activity score correlated with higher tibial internal rotation (r=0.44, p=0.02), higher tibial external rotation (r=0.39, p=0.04) and higher total tibial rotation (r=0.62, p<0.000)67 | |
| Episodes of knee instability | At 1-year postsurgery, prevalence of knee instability in patients returning to preinjury level of sport was less than in those who did not return to sport (44.2% vs 73.8%, p=0.004)69 | |
| Marx Activity Score (0 = lowest activity, 16 = highest activity) | At 2 years postsurgery, higher Marx Activity Score for patients who did return to sport versus did not return to sport (15 vs 7.5, p<0.001)62 | |
| Kinesiophobia (TSK score: 0 = lowest fear, 51 = highest fear; TSK-11 score: 11 = lowest fear, 44 = highest fear) | At 1-year postsurgery, lower TSK-11 score for patients returning to preinjury level of sport than those who did not return to sport (15.3 vs 19.6, p<0.01)69 | |
| Athletic confidence (ACL-RSI: 0 = lowest confidence, 100 = highest confidence) | At 1-year postsurgery, higher TSK score associated with lower likelihood of resuming previous level of activity (β=–0.40); fear of reinjury unique predictor of return to sport (R2=0.26)65 | |
| At 3–4 years postsurgery, lower TSK score for patients with return to preinjury level of sport versus decreased or no sports activity (15 vs 20, p=0.01)48 | ||
| At 6 months postsurgery, higher ACL-RSI for groups with return to preinjury level of sport than no return to sport (63.18 vs 51.80, p=0.005). At 1-year postsurgery, higher ACL-RSI for groups with full return to sport than no return to sport (72.05 vs 58.61, p=0.001)68 | ||
| At 1-year postsurgery, higher ACL-RSI for groups with return to preinjury level of sport versus no return to sport (70 vs 46, p<0.001)66 | ||
| Self-motivation (psychovitality questionnaire: (3 = lowest motivation, 18 = highest motivation) | Higher preoperative psychovitality score for group that did return to sport versus did not return to sport at 2 years postsurgery (16 vs 9, p<0.001)62 | |
| Higher preoperative psychovitality score correlated with higher Tegner activity score at 3 years postsurgery (R2 linear=0253)63 | ||
| Conflicting evidence54 for association with return to sport | Postoperative hamstring torque | At 1.5–2 years postsurgery, higher hamstring torque correlated with higher Tegner activity score (r=0.52)61 |
| At mean 7.9 years postsurgery, difference in max hamstring torque between surgical leg and non-surgical leg not different in group with return to preinjury level of sport (107 Nm), mild sports limitation (113 Nm), non-cutting sports (106 Nm) or no sports (104 Nm)59 | ||
| Hop testing/functional testing | At 1-year postsurgery, patients with LSI ≥85% on single-leg hop for distance and crossover hop for distance more likely to have attempted preinjury level of sport than patients with LSI <85% (risk ratio, 2.5; 95% CI 1.4 to 4.4)58 | |
| At 1.5–2 years postsurgery, faster 6 m shuttle run test correlated with higher Tegner activity score (r=0.57, p<0.05)61 | ||
| At 1-year postsurgery, no difference between groups with return to preinjury level of sport and no return to sport in LSI on single hop for distance (91% vs 89%, p=0.371) or crossover hop for distance (92% vs 92%, p=0.865)68 | ||
| At 1.5–2 years postsurgery, weak correlations between LSI on single hop for distance (r=0.13, p<0.05), triple hop for distance (r=0.08, p<0.05), crossover hop for distance (r=0.27, p<0.05), vertical jump test (r=0.15, p<0.05), 10-step climb test (r=0.25, p<0.05), step hop test (r=0.37, p<0.05) and Tegner activity score61 | ||
| IKDC Subjective Form Score (0 = lowest subjective rating, 100 = highest rating) | At 1-year postsurgery, higher IKDC subjective form score for patients returning to preinjury level of sport than those who did not return to sport (93.8 vs 78, p<0.001)69 | |
| At 5 years postsurgery, higher IKDC subjective form score for patients returning to preinjury level of sport (84.6) than those who did not return to sport due to fear of reinjury (73.5) or due to instability (60.1; between-groups difference, p<0.001)6 | ||
| At 2 years postsurgery, no difference between groups with return to preinjury level of sport versus decreased sports activity level or no sports activity62 | ||
| IKDC grade (A = normal, D = severely abnormal) | At 5 years postsurgery, greater percentage of patients returning to preinjury level of sport (89.3%) had IKDC grade A and B scores compared with those who did not return to sport due to fear of reinjury (77.7%) or due to instability (50%; between-groups difference, p=0.028)6 | |
| At 1-year postsurgery, no difference in return to sport outcomes between patients with IKDC grade A and B (risk ratio, 1.5; 95% CI 0.81 to 1.40). No difference in return to sport outcomes between patients with IKDC grade A and B and IKDC grade C and D (risk ratio 1.5; 95% CI 0.86 to 2.50)58 | ||
| At 2 years postsurgery no significant difference between groups with return to preinjury level of sport versus decreased sports activity level or no sports activity62 | ||
| Lysholm Knee Score (0 = worst function, 100 = highest function) | At 5 years postsurgery, higher Lysholm Knee Score for patients returning to preinjury level of sport (88.5) than those who did not return to sport due to fear of reinjury (84) or due to instability (72; between-groups difference, p=0.001)6 | |
| At 1.5–2 years postsurgery, no correlation with Tegner activity score61 | ||
| At 2 years postsurgery, no difference between groups with return to preinjury level of sport versus decreased sports activity level or no sports activity (p=0.38)62 |
ACL-RSI, anterior cruciate ligament-return to sport after injury scale; CKC, closed kinetic chain; IKDC, International Knee Documentation Committee; LSI, limb symmetry index; OKC, open kinetic chain; TSK, Tampa Scale of Kinesiophobia.