2015 ISAKOS Biennial Congress ePoster #1263
Assessment of Psychological Factors Associated with Return to Same Sport Following Anterior Cruciate Reconstruction: A Prospective Study Using the ACL-RSI Score at One Year Follow-Up
Yoann Bohu, MD, Paris FRANCE
Shahnaz Klouche, MD, Paris FRANCE
Serge Herman, MD, Paris FRANCE
Antoine Gerometta, MD, Paris FRANCE
Nicolas Lefevre, MD, Paris FRANCE
Clinique du Sport Paris V, Paris, FRANCE
FDA Status Cleared
Summary: This prospective study has shown that ACL-RSI score greater than 65/100 at 1 year was strongly related to the return to usual sports after adjusting for all other covariates. At 1-year follow-up, young male playing at competition level with ACL-RSI score up to 65/100 were more likely to resume their usual sport.
Studies have shown that many patients do not return to preoperative level sports after anterior cruciate ligament (ACL) reconstruction, despite excellent objective results. The ACL Return to Sports after Injury (ACL-RSI) is a validated scale which assesses the psychological impact of returning to sports in this population. The main objective of the study was to determine the threshold value of the ACL- RSI score above which the patient was likely to resume his usual sport. The secondary objective was to identify factors associated with return to sport after ACL reconstruction.
PATIENTS & METHODS
A prospective study conducted in 2012-2013 included all sports patients undergoing surgical reconstruction of isolated ACL tear in our department. At 6-month and 1-year follow-up, each patient was contacted by mail with a link to an electronic version of scales. The primary endpoint was the ACL-RSI score at 1-year follow-up. The optimal threshold score ACL-RSI value was determined with the ROC curve. A multivariate analysis was performed using logistic regression to identify factors associated with return to sport. Of 209 patients met the inclusion criteria, 172 (83.7%) have filled in the online questionnaires, 49 women and 123 men, mean age 31.2±9 years. Their sporting level was casual leisure (9.9%), regular leisure (44.8%), competition (39.5%) or professional (5.8%). Their usual sport was with pivot contact (67.4%), pivot without contact (18.6%) or without pivot (14%). The injury occurred mostly during sport activity (90.1%). The average follow-up was 15.7±2.1 (12-19.1) months.
A 1 year follow-up, 94% of patients returned to sports activity and 59% to their usual sport. Patients who resumed their usual sport had an ACL-RSI score significantly higher: 67.8±21.7% vs 53.4±19.8%, p=0.001. The IKDC objective was not significantly different between the 2 groups. The optimal threshold value was 65/100 (sensitivity=59.6%, specificity=73%, positive likelihood ratio=2.2, negative likelihood ratio=0.5). The multivariate model showed that factors related to the resumption of usual sport at 1-year follow-up were ACL-RSI score up to 65% (OR=3.3±1.8), male gender (OR=8.1±5), age<30 years (OR=4.1±2.4) and competition level (OR=2.5±0.9).
This study has shown that ACL-RSI score greater than 65/100 at 1 year was strongly related to the return to usual sports after adjusting for all other covariates. At 1-year follow-up, young male playing at competition level with ACL-RSI score up to 65/100 were more likely to resume their usual sport. Future recommendations should take into account all variables associated with return to sport to ensure that the athlete is physically and psychologically ready to return to usual sport and to avoid any further ACL rupture.