Factors Associated With a Successful Return to Performance After Anterior Cruciate Ligament Reconstruction: A Multiparametric Evaluation in Soccer Players

Background: Anterior cruciate ligament reconstruction (ACLR) is highly recommended in patients with ACL deficiency who must perform at a high physical level. A combination of functional and psychological outcome measures is necessary to provide a comprehensive evaluation of functional status after successful return to sport after ACLR. Purpose: To identify factors associated with higher functional outcomes among soccer players who had returned to full sports participation after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 168 out of 231 patients who underwent primary unilateral arthroscopic anatomic single-bundle ACLR were available at follow-up. Postoperatively, knee function, generic health outcomes, and psychological impact were assessed using the International Knee Documentation Committee (IKDC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm Knee Scoring Scale, the 12-item Short Form Health Survey (SF-12), and the ACL–Return to Sport after Injury scale. Results: After a mean follow-up of 35.5 ± 22.6 months, 85% of soccer players returned to performance. Midfielder position was associated with a better SF-12 Physical Component Summary (PCS) score ( P = .013), IKDC ( P = .003), total KOOS ( P < .001), KOOS Symptoms ( P = .004), KOOS Pain ( P = .029), KOOS Activities of Daily Living (ADL) ( P = .044), KOOS Sport and Recreation (Sport/Rec) ( P = .001), KOOS Quality of Life (QoL) ( P < .001), and Lysholm score ( P = .008). Playing only on natural grass was associated with lower SF-12 PCS scores ( P = .003), total KOOS ( P = .001), and KOOS Sport/Rec ( P = .011). Playing only on artificial turf was associated with lower Lysholm score ( P = .018) and total KOOS ( P = .014). The contact mechanism was associated with higher IKDC ( P = .044) and KOOS QoL ( P = .048), and injury affecting the dominant limb was associated with lower SF-12 Mental Component Summary scores ( P = .012). Playing at a nonprofessional level was associated with lower total KOOS ( P = .028), KOOS Symptoms ( P = .002), KOOS ADL ( P = .033), and KOOS Sport/Rec ( P = .016). Conclusion: Professional soccer players and the midfielder position are associated with better functional scores upon returning to the sport. A history of noncontact ACL injury and playing on a single type of surface are associated with lower functional outcomes upon returning to the sport. Lower mental health scores can be expected after injury of the dominant limb.