Study Of Factors And Assessment Indicators Influencing Return To Sports After Anterior Cruciate Ligament Reconstruction

Objective:(1)To investigate the current status of returning to sports after anterior cruciate ligament reconstruction(ACLR)in the general patients;(2)To analyze the factors related to return to sports;(3)To understand the usefulness of common return-to-sport assessment indicators in the general patients,to investigate the assessment indicators of return-to-sport after ACLR in the general patients,and to provide a decision basis for the rehabilitation and safe return-to-sport after ACLR in the general patients.In order to provide a basis for decision making in the ACLR rehabilitation and safe return to sport.Method:Post-operative ACLR rehabilitation cases from the last two years(July 2020 to December 2022)in Wuhan Win-Zeal Rehabilitation Medical Institution were selected in the study.Demographic characteristics of general patients were collected,and postoperative return to sports was followed up.Descriptive statistics of gender,age,and pre-injury and postoperative Tegner scores were performed for all patients.The exercise population was defined as 1)regular participate sports before the injury(at least 2 times per week)and 2)preoperative Tegner scores greater than or equal to 5.The return to sports was defined as 1)return to the pre-injury sports level and,2)return to sports with Tegner score greater than or equal to 5.The exercise population was divided into a return-to-sport group(RTS)and a non-return-to-sport group according to the definition of return-to-sport(NRTS),the patients’medical information was compiled to analyze the current status of return-to-sport and the factors affecting return-to-sport in the exercise population.The exercise population with telephone follow-up was invited to complete functional test assessment and questionnaire data collection,and the exercise population recruited to complete the test was divided into return-to-sport functional assessment group(RTS-assessment group)and non-return-to-sport functional assessment group(NRTS-assessment group)according to return-to-sport and non-return-to-sport,,including the modified Star Excursion Balance Test(SEBT),isometric maximal muscle strength test,single-leg hop test,and triple crossover hop test,and the limb symmetry index LSI(Limb Symmetry Index)=(affected side/unaffected side)× 100%.Patients’ psychological condition was assessed using the TSK-11(Tampa Scale of Kinesiophobia-11),and the Lysholm scores measured current knee symptoms and function.Numerical data were compared between groups using Independent Student’s t-test,Chi-Square test and Fisher’s Exact test was used for rating data,and Binary Logistic Regression analysis was used to determine the relevant factors influencing return to sport,and ROC curve was used to investigate the value of return to sport indicators for assessment,and P<0.05 was considered statistically significant.Results:(1)Among the 80 patients,71 were from the exercise population,9 were from the non-exercise population,88.8%were from the exercise population,85.9%were men from the exercise population,44.4%were men from the non-exercise population,the mean age of the exercise population group was 27.2±8.6,preo-injury Tegner score was 6.07±0.54,the mean age of the non-exercise population group was 34.3±8.8,pre-injury Tegner score was 3.78±0.97.50 of the 71 patients in the exercise population had a pre-injury Tegner score of 6,accounting for 70.4%,and 68 patients,accounting for 95.8%,had an injury during exercise.Fifty-two of the exercise population returned to sports,a return-to-sports rate of 73.2%.32 patients returned to pre-injury exercise level,accounting for 45.1%,20 patients returned to sports with a Tegner score of 5 or higher,accounting for 28.1%,and 19 patients did not return to sports,accounting for 26.8%.(2)There were statistically significant differences between the RTS group and the NRTS group in the postoperative knee discomfort(χ2=6.719,P=0.009)and pre-injury Tegner score(χ2=3.088,P=0.004);The postoperative knee discomfort were the relevant factors affecting return to sport,the patients with postoperative knee discomfort were 4.037 times more likely to be unable to return to sports than those with no knee discomfort.[95%confidence interval.1.233-13.211];P=0.021).(3)Among the patients who participated in the clinical functional assessment test and questionnaires,18 patients who returned to sports and 12 patients who did not return to sports,there was a statistical difference in the modified SEBT anterior LSI between the two groups(RTS-assessment group and N RTS-assessment group),and the modified SEBT anterior LSI threshold for determining return to sports was 98.2%,with a sensitivity of 88.9%,specificity of 58.3%,and area under the ROC curve of 0.722.Conclusion:(1)This research found that the most common cause of ACL injury in the general patients was sports injury,and the rate of return to sports after reconstruction was 73.2%,of which 45.1%of patients returned to pre-injury sports and 28.1%returned to sports with Tegner score of 5 and above,and the most common reason for not returning to sports was fear of re-injury.(2)The postoperative knee discomfort were the relevant factors affecting return to sport,and patients with postoperative knee discomfort were 4.037 times more likely to be unable to return to sports than those with no knee discomfort.(3)The threshold value of the return-to-sport assessment index was:modified SEBT anterior LSI=98.2%,with high sensitivity;and even after surgery,patients who returned to sport still had fear of hop test,suggesting that postoperative psychological rehabilitation is an area that needs to be strengthened in future clinical practice.