Abstract
Objectives:
While return to sport (RTS) has been well studied in young athletes after anterior cruciate ligament (ACL) reconstruction, there is a paucity of literature on RTS following reconstructive surgery for multi-ligament knee injury (MLKI). The purpose of this study is to assess level of RTS following MLKI in athletes 23 years old or younger at the time of injury and evaluate the factors associated with RTS.
Methods:
This was a retrospective study. We identified 116 patients at our Level 1 referral center who sustained MLKI at an age of 23 years old or younger. All 116 patients underwent operative reconstruction. Patients were contacted via mail and then completed surveys by telephone if willing to participate. Our primary outcome variable was self-reported ability to return to sport at their preoperative level or higher following surgery. Secondary variables included 2000 International Knee Documentation Committee Subjective Form (2000 IKDC-SF), ACL Return to Sport After Injury (ACL-RSI), and Short-Form 12 (SF-12) physical and mental health scales. Dependent variables included age, participation in cutting sports, number of and specific ligaments injured, and any concurrent mental health diagnoses.
Results:
A total of 30 (25.9%) patients completed surveys at an average follow-up of 7.8 years postoperatively (24 male, 6 female, 18.1±2.5 years old at time of injury). Of this cohort, 90% of patients returned to sport at some level, while 43.3% returned to their preoperative level or higher. Participation in cutting sports was associated with significantly lower rate of RTS at the same level or higher (p=0.017). Higher 2000 IKDC-SF and ACL-RSI scores were associated with significantly higher rate of RTS at the same level or higher (p=0.001 and 0.002, respectively). Patients who participated in higher level of sport preoperatively demonstrated a higher odds ratio (OR) of returning to their same athletic level or higher following MLKI (OR=3.516 [1.034-11.955]; p=0.044). Number of ligaments injured, age at time of injury, concurrent mental health diagnosis, and SF-12 scores were not associated with a statistically significant change in RTS at the same level or higher. Patients with concurrent ACL and MCL injuries trended toward higher rate of RTS at the same level or higher than two- or three-ligament injuries involving the ACL and PCL and/or LCL, but this was not statistically significant (50% vs. 25%, p=0.225).
Conclusions:
While a high percentage of young athletes return to some level of sport following MLKI, less than half return to their previous level. Those participating in cutting sports were significantly less likely to return to their pre-injury level of sport following MLKI. Participation in higher level of sport preoperatively was associated with a higher OR of return to sport at the same level or higher. Those who returned to the same level or higher reported significantly higher scores on the ACL-RSI and the 2000 IKDC-SF. There was no significant difference in those returning to sport at their previous level or higher based on SF-12 physical or mental scores, number of ligaments injured, presence of a mental health diagnosis, or age at injury. Future studies will focus on larger cohorts and any modifiable variables to obtain a functional return to sport.
