Psychological Readiness to Return to Sport at 6 Months Is Higher After Bridge-Enhanced ACL Restoration Than Autograft ACL Reconstruction: Results of a Prospective Randomized Clinical Trial

Abstract

Background: Previous clinical studies have shown that psychological factors have significant effects on an athlete’s readiness to return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR). Hypothesis: We hypothesized that patients who underwent bridge-enhanced ACL restoration (BEAR) would have higher levels of psychological readiness to return to sport compared with patients who underwent ACLR. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 100 patients (median age, 17 years; median preoperative Marx activity score, 16) with complete midsubstance ACL injuries were randomized to either the BEAR procedure (n = 65) or autograft ACLR (n = 35 [33 hamstring and 2 bone--patellar tendon—bone]) and underwent surgery within 45 days of injury. Objective, functional, and patient-reported outcomes, including the ACL--Return to Sport after Injury (ACL-RSI) scale, were assessed at 6, 12, and 24 months postoperatively. Results: Patients who underwent the BEAR procedure had significantly higher ACL-RSI scores at 6 months compared with those who underwent ACLR (71.1 vs 58.2; P = .008); scores were similar at 12 and 24 months. Baseline factors independently predictive of higher ACL-RSI scores at 6 months were having a BEAR procedure and participating in level 1 sports prior to injury, explaining 15% of the variability in the scores. Regression analysis of baseline and 6-month outcomes as predictors indicated that the International Knee Documentation Committee (IKDC) score at 6 months explained 45% of the 6-month ACL-RSI variance. Subsequent analysis with IKDC excluded from the model indicated that decreased pain, increased hamstring and quadriceps strength in the surgical limb, and decreased side-to-side difference in anteroposterior knee laxity were significant predictors of a higher ACL-RSI score at 6 months, explaining 34% of the variability in scores. Higher ACL-RSI score at 6 months was associated with earlier clearance to return to sports. Conclusion: Patients who underwent the BEAR procedure had higher ACL-RSI scores at 6 months postoperatively. Better ACL-RSI scores at 6 months were related most strongly to higher IKDC scores at 6 months and were also associated with lower pain levels, better muscle recovery, and less knee laxity at 6 months. Registration: NCT02664545 ( ClinicalTrials.gov identifier).

Bridge enhanced ACL repair vs. ACL reconstruction for ACL tears: A systematic review and meta-analysis of comparative studies

“…This can be explained by the fact that patients may have been more confident earlier in their postoperative course, due to the lack of donor-site morbidity from graft harvest in the BEAR group and, presumably, faster muscle recovery. Our findings showed better hamstring strengths in the BEAR group and a correlation between better psychological readiness scores and higher hamstring strength at 6 months was noted by Sanborn et al [26], which supports the notion of a mind-body connection during rehabilitation. Other factors that had a major influence on this score at 6 months are the participation in level 1 sports before the injury, and the postoperative IKDC score [26].…”

“…Our findings showed better hamstring strengths in the BEAR group and a correlation between better psychological readiness scores and higher hamstring strength at 6 months was noted by Sanborn et al [26], which supports the notion of a mind-body connection during rehabilitation. Other factors that had a major influence on this score at 6 months are the participation in level 1 sports before the injury, and the postoperative IKDC score [26]. This finding suggests that the patient's perceived knee function matches psychological readiness and that athletes may also have stronger athletic identities, which motivates them to adhere more strictly to recovery goals [28,29].…”

“…A study by Sanborn et al [ 26 ] compared the ACL Return to Sports after Injury (ACL-RSI) score in both the BEAR and ACLR techniques. The ACL-RSI cut-off score is set to be 65 as per Webster et al [ 27 ], 6 months postoperatively, the BEAR group attained this score while the ACLR group did not, however at 12 months postoperatively both groups preserved the same psychological readiness making this delay in psychological readiness a temporary and not a permanent issue.…”

Predicting anterior cruciate ligament failure load with T2* relaxometry and machine learning as a prospective imaging biomarker for revision surgery

“…As a result, a direct validation of the model failure load predictions could not be performed on patients, and thus were derived from porcine data, which were then normalized and scaled for human use. Therefore, the clinical impact of the estimated failure load scores was assessed by relating model predictions of failure load at 9 months (the time at which patients were permitted to return-to-sport 35,36 ) to revision surgery rates by 2 years. Furthermore, by converting the failure load prediction to a 0-1 score, the metric was normalized to the range of possible estimated failure load values, reducing the importance of the actual absolute value.…”

Return to Sport After an Anterior Cruciate Ligament Tear: Bridging the Gap Between Research and Practice

“…To recreate sport-specific skills, athletes should start with structured, closed practice movements and graduate to randomization and open practice movements (79). During rehabilitation, proprioception must also be challenged because it helps individuals return to sport with confidence (50).…”