Barriers to the return to sport after anterior cruciate ligament tear in operative vs conservative patients
Mr Olivier UCAYa, Dr Sophie GLEIZES CERVERAb, Ms Alice RENAULTc, Dr David GASQd
a CHU de Rangueil - Médecine physique et de réadaptation, b Clinique Medipole Garonne – 45 rue de Gironis – 31100 Toulouse, c Kinesitherapeute diplomée d'état, d Hopital de Rangueil - Explorations fonctionnelles physiologiques 1, avenue du Professeur Jean Poulhès - TSA 50032 - 31059 Toulouse cedex 9
Introduction: Return to sports (RTS) rates after anterior cruciate ligament tear (ACLT) is lower than expected despite good functional scores in operated (OP) as well as non-operated (NOP) patients. These barriers to RTS are not clear especially for NOP in the literature.
Aim: The purpose was to evaluate the subjective and objective outcomes associated with no RTS after ACLT in OP vs NOP.
Method: All patient within 6 months to 2 years from ligamentoplasty, and 1 to 2 years from injury for conservative treatment could be included. Exclusion criteria were history of ACL tear, posterior ligament surgery, neurologic injury and complex fracture. Return to sport (main sport, previous level, competition, with pivoting contact) was declarative but also measures as the variation of the global activity volume (Tegner score * weekly hours of practice). The subjective (stiffness, pain, effusion, instability, lack of strength, motivation or time, fear of re-injury) and objective barriers (demographic, clinical, functional and psychological scores) were collected
Results: 18 NOP (women 61%, mean-age 38y, leisure level) vs 40 OP (men 77%, mean-age 32y, competitors) were included 23 months after ACLT, 15 months after surgery. Half of the patients (50 vs 45%) returned to their main sport. RTS at previous level for the main sport remained uncertain, 33% for NOP vs 67% (p=0.1) for OP, whereas return to global activity level (based on Tegner score and sport hours) was 61% vs 18% (p=0.002). The main reason for no RTS was fear of re-injury (73 for NOP vs. 59% for OP), lack of time (27 vs. 36%) and pain (33 vs. 23%), lack of motivation (27 vs. 9%, p<0.05) and strength for OP (7 vs. 14%). Objective outcomes associated with no RTS were stiffness (p=0.011), low one-leg hop test performances (p=0.008); amyotrophy (p=0.004) and decreased physical self-perception (p=0.001) in OP ; weak IKDC (71, p=0.01) and KOOS (94, p=0.008) scores for NOP. Low ACL-RSI scores was associated with fear of re-injury (p =0.001).
Conclusion: Psychological factors (fear of re-injury, physical self-perception) largely influence RTS. These factors should help the decision for surgery or not after ACLT.
Keywords : Anterior cruciate ligament, operated, non-operated, return to sport, fear of re-injury