Predictive parameters for return to pre-injury level of sport 6 months following anterior cruciate ligament reconstruction surgery

Knee Surg Sports Traumatol Arthrosc. 2015 Dec;23(12):3623-31. doi: 10.1007/s00167-014-3261-5. Epub 2014 Sep 2.


Purpose: The aim of the study was to find predictive parameters for a successful resumption of pre-injury level of sport 6 months post anterior cruciate ligament (ACL) reconstruction.

Methods: In a prospective study, 40 patients with a ruptured ACL were surgically treated with semitendinosus tendon autograft. Six months after surgery, strength of knee extensors and flexors, four single-leg hop tests, Anterior Cruciate Ligament-Return to Sport after Injury Scale (ACL-RSI), subjective International Knee Documentation Committee (IKDC) 2000 and the Tampa Scale of Kinesiophobia-11 (TSK-11) were assessed. Seven months post-operatively, a standardized interview was conducted to identify "return to sport" (RS) and "non-return to sport" (nRS) patients. Logistic regression and "Receiver Operating Characteristic" (ROC) analyses were used to determine predictive parameters.

Results: No significant differences could be detected between RS and nRS patients concerning socio-demographic data, muscle tests, square hop and TSK-11. In nRS patients, the Limb Symmetry Index (LSI) of single hop for distance (p = 0.005), crossover hop (p = 0.008) and triple hop (p = 0.001) were significantly lower, in addition to the ACL-RSI (p = 0.013) and IKDC 2000 (p = 0.037). The cut-off points for LSI single hop for distance were 75.4 % (sensitivity 0.74; specificity 0.88), and for ACL-RSI 51.3 points (sensitivity 0.97; specificity 0.63). Logistic regression distinguished between RS and nRS subjects (sensitivity 0.97; specificity 0.63).

Conclusions: The single hop for distance and ACL-RSI were found to be the strongest predictive parameters, assessing both the objective functional and the subjective psychological aspects of returning to sport. Both tests may help to identify patients at risk of not returning to pre-injury sport.

Level of evidence: II.

Keywords: Anterior cruciate ligament rupture; Operative reconstruction; Predictors; Return to sport.

MeSH terms

  • Adult
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries*
  • Anterior Cruciate Ligament Reconstruction* / methods
  • Anterior Cruciate Ligament Reconstruction* / psychology
  • Female
  • Humans
  • Knee / surgery
  • Knee Injuries / surgery*
  • Knee Joint / surgery
  • Male
  • Postoperative Period
  • Prospective Studies
  • ROC Curve
  • Recovery of Function
  • Return to Sport* / psychology
  • Tendons / transplantation
  • Transplantation, Autologous
  • Young Adult