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Surgeon's advice not to return
2%
69/3794
Persistent knee pain
8%
285/3794
Duration of sport participation
4%
155/3794
Lifestyle and psychological factors
85%
3232/3794
Autograft harvasting surgical technique
1%
30/3794
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Athletes who do not return to their preinjury level of sport after primary ACL reconstruction despite having good knee function are largely influenced by lifestyle and psychological factors. The return to their preinjury level of sport is frequently expected within 1 year after anterior cruciate ligament (ACL) reconstruction, yet many athletes do not achieve this milestone. Having a previous ACL reconstruction to either knee, poorer hop-test symmetry and subjective knee function, and more negative psychological responses were associated with not returning to the preinjury level sport. Fear of reinjury is considered one of the most common reasons cited for a postoperative reduction in or cessation of sports participation. Tjong et al. conducted a qualitative study of 31 patients, aged 18 to 40 years, to understand the factors influencing a patient's decision to return to his or her preinjury level of sport after ACL reconstruction. They found 3 overarching factors what largely influenced their decision to return to the preinjury sport: fear, lifestyle changes, and innate personality traits. This highlighted the importance of recognizing and addressing the psychological factors and lifestyle changes that significantly contribute to a patient's postoperative decision to return to sport. Ardern et al. investigated the return-to-sport rates at 2 years after ACL reconstruction in athletes. At 2 years after surgery, 66% were playing sport, with 41% playing their preinjury level of sport and 25% playing a lower level of sport. Demographics, physical function, and psychological factors were supported as the most important influencing factors for the return to their preinjury level of sport. Incorrect Answers: Answer 1: Surgeon advice not to return is considered a weak influence on a competitive athletes decision to return to sport. Answer 2: Persistent knee pain with good functional knee outcomes scores is considered a weak influence on a competitive athletes decision to return to sport. Answer 3: Return to sport across different types of sports has shown to be similar across studies. This is considered a weak influence on a competitive athletes decision to return to sport. Answer 5: The type of autograft used in primary ACL reconstruction has not shown to influence a players decision to return to sport.
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