Factors Affecting Subjective and Objective Outcomes and Return to Play in Anterior Cruciate Ligament Reconstruction: A Retrospective Cohort Study

Purpose To analyze the prognostic factors influencing subjective and objective outcomes and return to play (RTP) after anterior cruciate ligament reconstruction (ACL-R). Methods Primary ACL-Rs using a transtibial technique performed between 2008 and 2012 were included. Data regarding patients, surgery, sports, and rehabilitation, including an on-field rehabilitation (OFR) and duration of the rehabilitation program, were collected. The International Knee Documentation Committee (IKDC) subjective andobjectiveevaluationforms,andtheKneeInjuryandOsteoarthritisOutcomeScore and Lysholm questionnaires were used for the assessment of subjective and objective outcomes. The Subjective Patient Outcome for Return to Sports and ACL–return to sportafterinjury(RSI)scoreswereusedforRTPevaluation.Severalpotentialpredictors of outcome were tested with a univariate analysis. All the variables with p < 0.1 were retestedinalogisticregressionmodeltoevaluatetheirassociationwiththeoutcomes. Results In total, 176 cases were included with an average follow-up of 44.1 months. Ofthepatients,92.2%wereratedasnormalornearlynormalattheIKDCevaluation.In addition, 90.1% of the patients returned to sport, with 57.6% returning to the same preinjury level. Objective outcomes were negatively influenced by late rehabilitation (odds ratio [OR] ¼ 2.75). Performing an OFR phase during the rehabilitation was associated with better subjective outcomes (OR ¼ 2.71). Length of rehabilitation strongly influenced the RTP rate (OR ¼ 13.16). Conversely, higher ACL-RSI score was inversely related to RTP. Objective IKDC score was inversely related to the ACL-RSI (OR ¼ 0.31),whereassubjectivescorewascorrelatedwithboththetotalACL-RSIscore (OR ¼ 0.15) and the level of activity (OR ¼ 0.20). Conclusion Thisstudyconfirmedtheroleofrehabilitationonsubjectiveandobjective outcomes and on RTP. Particularly, the complete adherence to a rehabilitation program, including an OFR phase, resulted in better subjective outcomes and higher RTP rate. The relationship between psychological factors, measured through the ACLRSI score, and RTP was confirmed.