New research published in the January 2017 issue of The American Journal of Sports Medicine suggests that a rate of return to usual sport instead of the broader rate of return to any kind of sport is a more accurate way to measure recovery from anterior cruciate ligament reconstruction.
552 Patient Study of ACL Reconstruction Return Rates
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Shahnaz Klouche, M.D., of the Clinique du Sport in Paris, France, and colleagues conducted a single-center, prospective cohort study involving athletes, aged 18 to 50 years, who had primary or revision isolated anterior cruciate ligament (ACL) reconstruction between 2012 and 2014.
Knee function (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS] scores) and psychological readiness (ACL-Return to Sports After Injury [ACL-RSI] score) at six months and one year were measured. The primary outcomes were return to sport at one year follow-up and return to usual sport at one year follow-up.
Five hundred and fifty-two patients participated in the study (primary reconstruction group: n = 497, revision reconstruction group: n = 55). According to the data, rate of return to any kind of sport at one year was comparable between primary ACL reconstruction (90.9%) and revision surgery (87.3%). However, two-thirds (63.6%) of the patients in the primary reconstruction group returned to their usual sport at one year compared with almost half (49.1%) of the patients in the revision reconstruction group.
In addition, the functional scores of the athletes were better in the primary reconstruction group for IKDC (p = 0.04); KOOS Symptoms/Stiffness (p = 0.02), activities of daily living (p = 0.04), sport (p = 0.0004) and quality of life (p < 0.00001) subscales and ACL-RSI (p < 0.00001).
“This study showed that in the same cohort, the rate of return to sport activity at one year was similar between the primary ACL reconstruction group and revision reconstruction group but patients in primary group have returned significantly more often to their usual sport than revision group,” Klouche told OTW.
He added, “The ACL-RSI is a relatively new scale and it seems strongly correlated with the ability of patients to return to sport especially in case of previous surgery. The usefulness of this score in daily clinical practice needs to be more assessed.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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