Return-to-Sport and Physical Activity Outcomes in Young Adults With Ongoing Knee Symptoms After Anterior Cruciate Ligament Reconstruction From the SUPER-Knee Trial

CONTEXT: Up to one-third of individuals following anterior cruciate ligament reconstruction (ACLR) report unacceptable symptoms after formal rehabilitation including poor function, pain, and instability. Ongoing symptoms are associated with reduced odds of returning to sport post-ACLR. In this exploratory study, we aimed to investigate return to sport and physical activity participation in young adults with ongoing knee symptoms after ACLR. DESIGN: Cross-sectional. METHODS: One hundred eighty-four participants aged 18-40 years with ongoing knee symptoms, 9 to 36 months following ACLR were included. Prevalence of (1) return to preinjury sport, (2) return to any sport, and (3) physical activity participation (ie, regular walking, running, swimming, cycling and/or gym) were reported. Logistic regression examined univariate associations between return to sport outcomes and individual demographic characteristics including age, sex, time between injury and ACLR, private health care for ACLR, lower-limb functional performance, and quadriceps strength in separate models. RESULTS: Of those who played sport in the year before ACL injury, 18% (n = 28) had returned to preinjury sport and 24% (n = 37) had returned to any sport (mean 2.3 years after ACLR). Across the cohort, the median number of weekly physical activity sessions was similar between preinjury (4 [interquartile range (IQR) 2-6]) and at 9 to 36 months (4 [IQR 1-6]). Single-forward hop limb symmetry ≥90% was associated with return to preinjury sport (odds ratio 3.95; 95% CI, 1.61-9.65) and return to any sport (odds ratio 2.97; 95% CI, 1.38-6.41). No other variables were associated with return to sport outcomes. CONCLUSIONS: Return to sport rates among young adults with ongoing knee symptoms following ACLR are low. Median number of weekly physical activity sessions was similar between preinjury (4 [IQR, 2-6]) and at 9 to 36 months (4 [IQR, 1-6]). Achieving ≥90% single-forward hop limb symmetry following rehabilitation appears to be associated with greater likelihood of returning to sport.