Return to Level I Sports After Anterior Cruciate Ligament Reconstruction: Evaluation of Age, Sex, and Readiness to Return Criteria

Abstract

Background: Return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction is a topic of current interest. The high reinjury rates reported in younger athletes may be due in part to an early RTS. Purpose: To determine the proportion of athletes who return to level I (jumping, hard pivoting, and cutting) sport at less than 1 year after ACL reconstruction and compare return rates by age and sex. A secondary purpose was to examine whether RTS is associated with some commonly used outcome criteria. Methods: A cohort of 1440 athletes (992 males, 448 females) satisfied criteria for inclusion in this study (primary ACL reconstruction, normal contralateral knee, no additional surgery within the first year after the reconstruction, and participation in level I sport on a weekly basis prior to injury). The proportion of athletes in this sample who had resumed level I sport by 12 months after surgery was recorded, along with measurements of knee function (single-legged hop symmetry), laxity (KT-1000 arthrometer), and self-reported outcomes (International Knee Documentation Committee [IKDC] subjective score). Limb symmetry index scores of 90 or higher, side-to-side difference in anterior knee laxity of 2 mm or less, and IKDC scores of 95 or higher were considered indicators of satisfactory recovery from surgery. Results: Rates of return to level I sport were significantly higher for athletes aged 25 years and younger (48% return rate) compared with older athletes (26-35 years, 32% return rate [ P < .0001]; ≥36 years, 19% return rate [ P < .001]). Male athletes who were in the ≤25-year and 26- to 35-year age brackets had significantly higher return rates than female athletes (52% vs 39% and 37% vs 18%, respectively), whereas no sex-based differences in RTS were seen after 36 years of age. A significantly higher proportion of younger patients met the selected indicators of a satisfactory recovery. Regardless of age, athletes had twice the odds of RTS if they had limb symmetry index scores of 90 or higher ( P ≤ .0001) and 3 times the odds of RTS if they had IKDC scores of 95 or higher ( P < .0001). Conclusion: Almost half of younger athletes (aged ≤25 years) in the current cohort returned to level I sports within 12 months after ACL reconstruction. Younger athletes were also more likely to meet criteria that indicate a satisfactory functional recovery and that have been used to indicate readiness to RTS. There may be a role for adjusting thresholds for these criteria based on age.