Rehabilitation, Decision-Making, and Return to Pivoting Sports in Athletes 1–3 Years After ACL Reconstruction: A Nationwide Study

OBJECTIVE: To describe rehabilitation and decision-making from ACL reconstruction to return to sport (RTS), characteristics and RTS proportions for pivoting sports athletes undergoing usual care. DESIGN: Cross-sectional study. METHODS: We invited people with ACL reconstruction who were aged 16-40 years, and injured during soccer, handball, or basketball, and registered in the Norwegian Knee Ligament Register, to complete a study-specific questionnaire at 1-3 years post-surgery. We reported descriptive statistics and RTS proportions for return to participation, sport and performance. RESULTS: Of 1,875 individuals, 631 (34%) responded. The physical therapist-led rehabilitation ceased before 9 months in 52% (n=268), and a physical therapist was most frequently involved in RTS decisions (n=462, 77%). Fifty-five percent (n=353) of the participants underwent physical testing prior to RTS. At a mean of 2.3 years (SD=0.8) after ACL reconstruction, 62% (n=391) returned to participation, 50% (n=312) returned to sport, and 17% (n=93) returned to pre-injury performance. The main reasons for non-return were fear of re-injury (35%, n=27) and knee problems (35%, n=27). Median time to RTS was 12 months (interquartile range 10 to 15 months), and 16% (n=102) had sustained a new ACL injury at follow-up. CONCLUSION: This nationwide study found that half of pivoting sport athletes ceased rehabilitation within 9 months, half performed physical testing to inform RTS, with physical therapists most frequently involved in the RTS-decision. Half of the athletes returned to sport, and one in six returned to performance. RTS proportions were highest in athletes younger than 20 years.