Preoperative predictors for return to physical activity following anterior cruciate ligament reconstruction (ACLR): a systematic review

Abstract

Abstract Background Rates of return to physical activity after anterior cruciate ligament reconstruction surgery are sub-optimal. Optimising presurgical treatment may improve return rates. The purpose of this systematic review was to identify modifiable preoperative predictors for return to physical activity after anterior cruciate ligament reconstruction. methods Six electronic databases ( CINAHL, AMED, MEDLINE, SPORTDiscus and PsycINFO via EBSCOhost and Web of Science) were searched from inception to 31 December 2021. The population of focus was adults aged 18–65 who had undergone primary anterior cruciate ligament reconstruction. Studies needed to identify at least one potential modifiable preoperative predictor variable and the relationship between the predictor(s) and return to physical activity. All time-points of assessment and study designs were included. Data extraction was completed by one reviewer and verified by a second reviewer. Two reviewers completed the risk of bias assessment using the Quality in Prognostic Studies tool and Grading of Recommendations Assessment, Development and Evaluation system. Results The search identified 345 studies, eight met the inclusion criteria. Five studies scored 'high’, and three studies scored ‘moderate’ risk-of-bias. All preoperative predictors were of very low-quality evidence. Five different outcome measures were used to assess return to physical activity including Tegner, Marx, Physical Activity Scale, return to play at the elite level and return to preinjury level (undefined). This was measured between 1 and 10 years post-surgery. Nine preoperative physical, six psychosocial and five demographic/clinical factors were assessed and five factors were found to be predictive. These included anterior knee laxity, quadriceps strength, psychological profile, patient estimated ability to return and graft type (patella tendon). Conclusion Very low-quality evidence supports preoperative physical, psychosocial and demographic/clinical factors to be predictive of return to physical activity between one- and ten-years after anterior cruciate ligament surgery. Trial registration This study was prospectively registered in PROSPERO: CRD 42020222567.