Investigating Participation in Level I/II Activities of Potential Copers and Non-Copers Twelve Months After Anterior Cruciate Ligament Reconstruction
Date
2012-05
Authors
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Publisher
University of Delaware
Abstract
A common success measure for athletes sustaining an anterior cruciate ligament (ACL) injury is their ability to return to sport (RTS) activity. The University of Delaware uses a functional test battery to determine a minimum state of readiness for RTS, utilizing hop tests, objective strength measures and self-reported knee function. Patients complete questionnaires about their perceived knee function, current activity, and what limits their ability to return to their previous level of athletic activity. Hartigan and colleagues found that 78% of non-copers passed the University of Delaware’s RTS criteria 12 months after surgery; the rate of these individuals returning to their previous activity level is still unknown. There is a need to learn how many of these athletes actually return to previous levels of activity and investigate reasons that may prevent return to pre-injury sports or recreational activities. This study examined athletes 12 months after ACL reconstruction. The purpose of the study was to (1) evaluate the rate of athletes returning to activity; (2) evaluate activity level based on the Marx Activity Rating Scale (MARS) and (3) investigate reasons for not returning to the same level of activity, despite meeting clinical RTS criteria. Data were collected twelve months after reconstruction from a total of 88 non-copers (N=52) and potential copers (N=36), with an average age of 29 years. The athletes in this study were high-level athletes involved in Level I/II activities, which include cutting, pivoting, and jumping. The MARS asks questions specific to the frequency with which these athletes are running, cutting, jumping and pivoting. Two supplemental questions from the information packet were used that asked the patients to describe 1) reasons why they have not returned to all pre-injury sports, and 2) why they have not returned to the same level of competition within the sport. The pass rate for of RTS criteria was 92.0%. However, the overall return to activity rate was only 60.2% with 80.6% of potential copers and 46.2% of non-copers returning to previous activity levels. The study also found the MARS scores were inconsistent with patient reported level of activity. The MARS scores frequently indicated an activity level higher than the self-reported level, creating an inconsistency between the activity score and the athletes’ self-reported RTS. Patients listed “fear of re-injury”, “too little time to participate” and “not yet cleared from doctor”, as the predominant reasons for not returning to the same level of activity, despite their clinical clearance for RTS. Results indicate the longer it takes for an athlete to pass RTS criteria, the less likely they are to return to their previous level of activity. Although patients may pass RTS criteria, they may not return to same level of activity potentially due to fear or lifestyle limitations. Non-copers demonstrate the need for additional evaluation and education to increase their likelihood of participating in higher level activities. The outcomes here reveal the need to intervene with athletes’ activity level after ACLR, to increase the percentage of individuals who pass the clearance functional tests and who engage in fifty hours or more of level I/II sports a year.
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Keywords
anterior cruciate ligament injury, ACL injury, return to sport activity, anterior cruciate ligament reconstruction