Rates and Determinants of Returning to Australian Rules Football in Male Nonprofessional Athletes After Anterior Cruciate Ligament Reconstruction

Abstract

Background: Return to sport is a goal for most patients who undergo anterior cruciate ligament (ACL) reconstruction. However, at a nonelite level, there are limited sport-specific data regarding rates or factors associated with return to play. Purpose: To report rates and determinants of returning to play Australian Rules football after ACL reconstruction in male nonprofessional athletes. Study Design: Case-series; Level of evidence, 4. Methods: A total of 354 male nonprofessional Australian Rules football players who had undergone primary ACL reconstruction were asked to complete detailed sports activity questions at 12 months and 2 to 5 years (mean, 3 years) after surgery. Rates of return to play were calculated for both timepoints, along with preoperative patient expectations and postoperative sport performance. The following predictors of return to play were examined: age at surgery; height; weight; frequency of weekly football participation; sport participation level; psychological readiness to return to sport; and knee-related quality of life. Further ACL injuries were also documented. Descriptive statistics were used to summarize return-to-play data and contingency analysis for predictors of return to sport. Results: The rate of return to any level of play was 35% (95% CI, 30%-41%; n = 284) at the 12-month follow-up and 78% (95% CI, 72%-83%; n = 233) at the 2- to 5-year follow-up. Overall, 64% (95% CI, 57%-70%) of the patients were able to return to their same or higher level of play. Before surgery, 92% of the patients expected to return to their same preinjury level of Australian Rules football participation. At the 2- to 5-year follow-up, 61% who returned to play felt that they could perform as well as they could before their ACL injury. A greater psychological readiness to return to sport preoperatively and higher level of sport participation were significant predictors of a return at 2 to 5 years. Further ACL injuries were sustained by 21% of the cohort (15% graft rupture; 6% contralateral ACL injury). Conclusion: Most male athletes who participate in Australian Rules football returned to some level of play after ACL reconstruction; however, only 64% returned to preinjury levels. Preoperative expectations were not met, and high reinjury rates are a cause for concern.

Multi-planar instability, laxity and reduced knee flexion during the support phase of walking are determinants of return to sports

“…Whether patients are suitable for returning to sports is usually determined by their performance on the RTS tests. However, under the current RTS criteria, the recent return-to-sports rate in most studies are unsatisfactory, ranging from 15.5% to 64% ( Lefevre et al, 2017 ; Rahardja et al, 2021 ; Webster et al, 2022 ). In addition, with the lack of adequate kinematic studies, there is a considerable debate about the value of RTS tests in identifying patients who are at higher risk of reinjury ( Gokeler et al, 2022 ; Hurley et al, 2022 ).…”

Return to Work After Anterior Cruciate Ligament Reconstruction: A Systematic Review

“…While the timing of return to work (RTW) after ACL surgery is a relevant variable, it is a less studied milestone compared with return to sports in patients undergoing ACLR. 9 , 32 …”

“…While the timing of return to work (RTW) after ACL surgery is a relevant variable, it is a less studied milestone compared with return to sports in patients undergoing ACLR. 9,32 Studies have shown that ACLR successfully restores knee function, 6,15,31 with 70% to 90% return-to-sports rate reported in the literature at 9 to 12 months postoperatively. 13,17,32 However, research evaluating the impact of ACLR on the ability of patients to RTW after surgery is currently limited.…”

“…9,32 Studies have shown that ACLR successfully restores knee function, 6,15,31 with 70% to 90% return-to-sports rate reported in the literature at 9 to 12 months postoperatively. 13,17,32 However, research evaluating the impact of ACLR on the ability of patients to RTW after surgery is currently limited. 27 Recent studies assessing RTW after ACLR have been conducted in small sample sizes with heterogeneous patient populations and considerable variability in surgical technique; this may limit the accuracy and generalizability of available data.…”