Most recreational sports patients require up to 2 years for near complete recovery of preinjury knee function after ACL reconstruction
Currently, there is a lack of consensus on the ideal time on return to sports post Anterior Cruciate Ligament (ACL) reconstruction surgery. 12 months have often been used as a guideline on patient’s return to sports. However, there is little data to show that patients are fully functional by this arbitrary time point. In our centre, we have observed that many of the patients have not returned to pre-injury sports by 12 months, and only started to approach pre-injury levels at later follow-ups.
The primary outcome of our study is to evaluate if patients continue to improve in functional status between 1 and 2 years post-operatively based on validated knee scores, namely the International Knee Documentation Committee (IKDC) subjective, Lysholm and Tegner scores. The secondary outcome is to evaluate the proportion of patients who returned to pre-injury sports at 1 year VS 2 years.
Design and Methods
A prospective review of 56 patients (42 males, 12 females) at a mean age of 27.1 years who underwent 4-strand hamstring graft ACL reconstruction by a single experienced surgeon in our centre was conducted. They were evaluated pre-operatively, and at regular intervals post operatively. IKDC subjective, Lysholm and Tegner scores were collated at each follow up. Data were analysed with student T test pre-operatively, at 1 year and at 2 years. The proportion of patients who returned to pre-injury levels was tabulated based on the attainment of pre-injury Tegner scores at 1 and 2 years.
IKDC subjective improved significantly between 1 year (81.1) and 2 years (86.9), p=0.016. Tegner scores also increased from 1 year (5.6) to 2 years (6.4), p=0.053. There was no difference in Lysholm scores between 1 year (91.4) and 2 years (90.2), p=0.52. When IKDC grades were evaluated, pre-operatively, there were 2 IKDC A, 7 IKDC B and 40 IKDC C. At one year, there were 19 IKDC A, 17 IKDC B and 1 IKDC C. And at 2 years after surgery, there were 38 IKDC A and 18 IKDC B and 0 IKDC C. In addition, 24% of patients returned to pre-injury level at 1 year compared to 51% at the 2 year mark.
The significant improvement in IKDC scores and grades between 1 and 2 years post-operatively give good evidence that patients continue to improve beyond the 1 year mark after ACL reconstructive surgery. They are also closer to their pre-injury functional status 2 years post surgery.
Evidence: Level 2C therapeutic study.