Psychological, physical and social factors influence decision to return to sport after revision ACL reconstruction with BPTB graft

Knee Surg Sports Traumatol Arthrosc. 2022 Apr;30(4):1336-1340. doi: 10.1007/s00167-021-06582-z. Epub 2021 Apr 25.

Abstract

Purpose: There is limited evidence in literature regarding the patient-reported factors that influence their return to sport (RTS) in revision anterior cruciate ligament reconstruction (ACLR). The medium-term results of a prospective consecutive cohort of patients undergoing single- and two-stage revision ACLR with bone patellar tendon bone graft (BPTB) and patient-reported factors that influence their decision to return to sport are presented in this study.

Methods: Seventy-two patients were included in this prospective study. Single- or two-stage revision with BPTB graft was performed based on pre-operative planning. Iliac crest bone graft was used. Pre-operative and follow-up Lysholm and Tegner activity scores and RTS, level of sport and patient-reported factors affecting RTS were recorded. The mean follow-up was 9 years (SD 2.7 years).

Results: Single-stage revision ACLR was performed in 61 patients. In 11 patients (15%), revision ACLR was performed in two stages. There was a significant improvement in Lysholm score from mean 51.1 to 86.7 (p < 0.001). The incidence of re-rupture in this cohort was 0%. The median Tegner score was 6 (range 2-9). Twenty-five patients (34.7%) did not return to any sport at final follow-up. Twenty-nine (40.2%) patients returned to their pre-injury level of sport. Fear of reinjury (79%, p < 0.001) and persistent knee symptoms (35.8%, p = 0.03) were the most common factors limiting RTS in non-returners.

Conclusion: Psychological and social factors may have an influence on RTS in addition to physical factors.

Level of evidence: Level III.

Keywords: Anterior cruciate ligament; Bone patellar tendon bone autograft; Psychological factors; Revision.

MeSH terms

  • Anterior Cruciate Ligament Injuries* / surgery
  • Anterior Cruciate Ligament Reconstruction* / methods
  • Humans
  • Prospective Studies
  • Reoperation
  • Return to Sport
  • Social Factors