Sustained Pre-Injury Physical Activity Post-ACL Reconstruction Linked to Greater RTS Readiness

Overview

Patients who maintain their pre-injury physical activity levels 3–5 years after ACL reconstruction demonstrate greater psychological readiness to return to sports at 18 months post-surgery. Maintaining physical activity post-ACL reconstruction is crucial for long-term health and knee function.

Background

Anterior cruciate ligament (ACL) injuries often lead to reduced physical activity (PA) and changes in activity type. Despite rehabilitation, only about half of patients return to competitive sport, and two-thirds return to their pre-injury sport level within seven years. Psychological factors such as fear of re-injury, self-efficacy, motivation, and readiness influence return to sport outcomes. Maintaining PA is important to reduce risks of non-communicable diseases and osteoarthritis, which is common after ACL reconstruction.

Data Highlights

The study utilized the modified Tegner Activity Scale to assess PA levels pre-injury, at 18 months, and 3–5 years post-ACL reconstruction. Patients were categorized based on whether they maintained or did not maintain their pre-injury PA levels at long-term follow-up. Psychological readiness and self-reported knee function were compared between groups.

Key Findings

• Patients maintaining pre-injury PA levels 3–5 years post-ACL reconstruction showed greater psychological readiness to return to sport at 18 months post-surgery.
• Approximately 50% of patients return to competitive sport, and two-thirds return to pre-injury sport levels within seven years.
• Lower fear of re-injury, higher knee function self-efficacy, and greater motivation characterize patients who successfully return to sport.
• Maintaining PA post-ACL reconstruction is essential to minimize risks of osteoarthritis and other non-communicable diseases.
• Exercise therapy focusing on knee extensor strength is recommended to reduce osteoarthritis symptoms and support PA maintenance.

Clinical Implications

Clinicians should emphasize the importance of maintaining or returning to pre-injury physical activity levels after ACL reconstruction to enhance psychological readiness for sports participation. Incorporating psychological support and targeted exercise therapy may improve long-term PA maintenance and knee health. Monitoring PA levels using tools like the Tegner scale can guide rehabilitation progress and patient counseling.

Conclusion

Sustaining pre-injury physical activity levels years after ACL reconstruction is associated with greater psychological readiness to return to sport, underscoring the need for comprehensive rehabilitation strategies that support both physical and psychological recovery.

References

1. World Health Organization 2020 -- Guidelines on physical activity and sedentary behaviour
2. Ithurburn et al. -- Self-reported knee function and sport maintenance post-ACL reconstruction
3. Project ACL -- Rehabilitation outcome register data