Return to preinjury sport after ACL injury treated with rehabilitation alone or ACL reconstruction: Results from the NACOX prospective cohort study

OBJECTIVES: In patients with ACL injury treated according to clinical practice, to explore: (1) the rate and time from injury to return to pre-injury sport IKDC sports level (RTS), (2) RTS rates to specific sports, and (3) patients' reported knee function. DESIGN: Prospective multicentre cohort study. PARTICIPANTS: 270 patients (53% females). Within three years of the injury, 178 patients (66%) had undergone ACL reconstruction (ACLR). MAIN OUTCOME MEASURES: Time from injury to RTS. Patient-reported knee function was evaluated with the Single Numeric Assessment Scale (SANE). RESULTS: Overall, 210 (78%) patients RTS. IKDC level-I and level-II patients RTS later (12 [95% CI 10-13] and 10 [95% CI 7-13] vs. 2 [95% CI 2-3] months, p < 0.001) and fewer RTS compared to IKDC level-III patients (66% vs. 76%, compared to 100%, p < 0.001). RTS rates for football were 60%, floorball 71%, handball 88%, and running 100%. SANE did not differ between the IKDC level groups at follow-ups; however, IKDC level-III patients reported lower SANE at RTS. CONCLUSIONS: Patients RTS to all sports level regardless of ACLR. Fewer patients in sports placing high demands on the knee RTS, and they RTS later compared to sports that are less demanding on the knee.