Return to sport after ACL reconstruction: how, when and why? A narrative review of current evidence

Abstract

Allowing a patient to return to sport and unrestricted physical activity after ACL injury and reconstruction is one of the most challenging and difficult decisions an orthopaedic surgeon has to make. Indeed, many factors have to be taken into account before it can be considered safe for a patients to load a reconstructed knee. The current literature contains plenty of studies aimed at evaluating return to sport, and the factors that may affect or predict this outcome, e.g. intrinsic factors like genetics, biology, type of lesion, anatomical features, motivation and psychology, and extrinsic factors such as graft type, surgical technique, rehabilitation protocols, and biological support. It is possible that awareness of these issues could help the clinician to optimise outcomes, and possibly avoid failures too, although as yet no universal criteria for resuming sport have been produced.

Knee function among elite handball and football players 1‐6 years after anterior cruciate ligament injury

“…Criteria for return to play after ACL reconstruction are a matter of discussion, and there is a need for more sports‐specific and patient‐tailored protocols . The most commonly used criteria are time since surgery, knee range of motion, functional tests (e.g.…”

“…[8][9][10][11] Criteria for return to play after ACL reconstruction are a matter of discussion, and there is a need for more sports-specific and patient-tailored protocols. 12,13 The most commonly used criteria are time since surgery, knee range of motion, functional tests (e.g. hop tests), balance, and, in particular, isokinetic strength tests of the quadriceps and hamstrings muscles.…”

Return to Sport after ACL Surgery: A Comparison between Two Different Reconstructive Techniques

“…20 Indeed, Zaffagnini et al highlighted how in the literature there is a lack of a reliable tool that can guarantee patient's return to sport. 21 Currently, in the literature different ACL reconstruction surgical techniques are mentioned without, however, establishing an effective advantage of a procedure Fig. 1 International Knee Documentation Committee (IKDC) objective results.…”

Graft choice has no significant influence on the rate of return to sport at the preinjury level after revision anterior cruciate ligament reconstruction: a systematic review and meta-analysis

“…Thus, return to sport protocols, even for primary ACL reconstruction, are largely surgeon-dependent and have not been fully standardised to date 39. Nevertheless, it is important for surgeons to use specific, objective criteria that patients must meet before returning to sporting activities 40.…”