Return to Preinjury Sports Participation Following Anterior Cruciate Ligament Reconstruction: Contributions of Demographic, Knee Impairment, and Self-report Measures

STUDY DESIGN: Cross-sectional cohort. OBJECTIVES: (1) To examine differences in clinical variables (demographics, knee impairments, and self-report measures) between those who return to preinjury level of sports participation and those who do not at 1 year following anterior cruciate ligament reconstruction, (2) to determine the factors most strongly associated with return-to-sport status in a multivariate model, and (3) to explore the discriminatory value of clinical variables associated with return to sport at 1 year postsurgery. BACKGROUND: Demographic, physical impairment, and psychosocial factors individually prohibit return to preinjury levels of sports participation. However, it is unknown which combination of factors contributes to sports participation status. METHODS: Ninety-four patients (60 men; mean age, 22.4 years) 1 year post-anterior cruciate ligament reconstruction were included. Clinical variables were collected and included demographics, knee impairment measures, and self-report questionnaire responses. Patients were divided into yes return to sports or no return to sports groups based on their answer to the question, Have you returned to the same level of sports as before your injury? Group differences in demographics, knee impairments, and self-report questionnaire responses were analyzed. Discriminant function analysis determined the strongest predictors of group classification. Receiver-operating-char-acteristic curves determined the discriminatory accuracy of the identified clinical variables. RESULTS: Fifty-two of 94 patients (55%) reported yes return to sports. Patients reporting return to preinjury levels of sports participation were more likely to have had less knee joint effusion, fewer episodes of knee instability, lower knee pain intensity, higher quadriceps peak torque-body weight ratio, higher score on the International Knee Documentation Committee Subjective Knee Evaluation Form, and lower levels of kinesiophobia. Knee joint effusion, episodes of knee instability, and score on the International Knee Documentation Committee Subjective Knee Evaluation Form were identified as the factors most strongly associated with self-reported return-to-sport status. The highest positive likelihood ratio for the yes-return-to-sports group classification (14.54) was achieved when patients met all of the following criteria: no knee effusion, no episodes of instability, and International Knee Documentation Committee Subjective Knee Evaluation Form score greater than 93. CONCLUSION: In multivariate analysis, the factors most strongly associated with return-to-sport status included only self-reported knee function, episodes of knee instability, and knee joint effusion. LEVEL OF EVIDENCE: Prognosis, level 2b. J Orthop Sports Phys Ther 2012;42(11):893-901, Epub 2 August 2012. doi:10.2519/jospt.2012.4077