Return to Sport After Primary and Revision Anterior Cruciate Ligament Reconstruction: A Prospective Comparative Study of 552 Patients From the FAST Cohort

Abstract

Background: Few studies have reported the return-to-sport rate at 1-year follow-up after primary and revision anterior cruciate ligament (ACL) reconstruction. Purpose: To compare the return-to-sport rate 1 year after primary and revision ACL reconstruction in the same cohort according to 2 modalities: any kind of sport and the patient’s usual sport at the same level as before the injury. Study Design: Cohort study; Level of evidence, 3. Methods: A single-center, prospective cohort study of patients undergoing ACL reconstruction (French prospective Acl STudy [FAST]) was begun in 2012. A comparative study was performed based on a retrospective analysis of data collected prospectively. Included were all athletes aged 18 to 50 years who underwent primary or revision isolated ACL reconstruction between 2012 and 2014. Two groups were formed: primary reconstruction and revision reconstruction. The main criterion was return to sport at 1-year follow-up (yes/no); secondary criteria were return to the usual sport at 1-year follow-up, knee function (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS] scores), and psychological readiness (ACL–Return to Sports after Injury [ACL-RSI] score) at 6 months and 1 year. Results: A total of 552 patients (primary reconstruction group: n = 497, revision reconstruction group: n = 55) were included in the study. There were 373 men and 179 women (mean [±SD] age, 30.2 ± 8.4 years). No significant difference in the return-to-sport rate was found between the 2 groups at 1-year follow-up (primary reconstruction group: 90.9%, revision reconstruction group: 87.3%; P = .38), but patients in the primary reconstruction group resumed their usual sport significantly more often (primary reconstruction group: 63.6%, revision reconstruction group: 49.1%; P = .04). Eight (1.4%) retears occurred during a new sport-related injury within a mean 8.9 ± 2.9 months: 7 (1.4%) in the primary reconstruction group and 1 (1.8%) in the revision reconstruction group ( P = .8). At 1-year follow-up, functional scores were significantly better in the primary reconstruction group for subjective IKDC (82.6 ± 13.3 vs 78.4 ± 16.6; P = .04); KOOS Symptoms/Stiffness (73.3 ± 15.2 vs 67.7 ± 19.6; P = .02), Activities of Daily Living (96.3 ± 6.4 vs 94.3 ± 9.1; P = .04), Sport (79.7 ± 19.1 vs 69.1 ± 24.8; P = .0004), and Quality of Life (69.6 ± 22.7 vs 54.7 ± 24.8; P < .00001) subscales; and ACL-RSI (65 ± 23 vs 49.5 ± 24.8; P < .00001). On multivariate analysis, patients who were more likely to resume their usual sport at 1 year were high-level players (odds ratio [OR], 2.2) who underwent primary reconstruction (OR, 2.0) and had better KOOS Quality of Life (OR, 1.7) and subjective IKDC (OR, 2.1) scores at 6-month follow-up without complications or retears during the first postoperative year (OR, 2.6). Conclusion: At 1-year follow-up, there was no significant difference in the return-to-sport rate between primary and revision ACL reconstruction. Patients who underwent primary reconstruction returned to their usual sport significantly more often. Trial Registration: NCT02511158 ( ClinicalTrials.gov identifier).