Rehabilitation, Decision Making, and Return to Pivoting Sports in Athletes 1-3 Years After ACL Reconstruction: A Nationwide Study

OBJECTIVE: To describe rehabilitation and decision making from anterior cruciate ligament (ACL) reconstruction to return to sport (RTS), characteristics, and RTS proportions for pivoting sport athletes undergoing usual care. DESIGN: Cross-sectional study. METHODS: We invited people with ACL reconstruction (ACLR) aged 16-40 years, who were injured during soccer, handball, or basketball and registered in the Norwegian Knee Ligament Register to complete a study-specific questionnaire at 1-3 years post-surgery. We reported descriptive statistics and RTS proportions for return to participation, sport, and performance. RESULTS: Of 1 875 individuals, 631 (34%) responded. The physical therapist–led rehabilitation ceased before 9 months in 52% (n = 268), and a physical therapist was most frequently involved in RTS decisions (n = 462, 77%). Fifty-five percent (n = 353) of the participants underwent physical testing prior to RTS. At a mean of 2.3 years (SD = 0.8) after ACLR, 62% (n = 391) returned to participation, 50% (n = 312) returned to sport, and 17% (n = 93) returned to preinjury performance, with higher rates for those under 20 years old. The main reasons for nonreturn were fear of reinjury (35%, n = 27) and knee problems (35%, n = 27). Median time to RTS was 12 months (interquartile range, 10-15 months), and 16% (n = 102) had sustained a new ACL injury at follow-up. CONCLUSION: This nationwide study found that half of pivoting sport athletes ceased rehabilitation within 9 months and half performed physical testing to inform RTS, with physical therapists most frequently involved in the RTS decision. Half of the athletes returned to sport, and 1 in 6 returned to performance. RTS proportions were highest in athletes younger than 20 years. JOSPT Open 2025;3(1):45-58. Epub 10 September 2024. doi:10.2519/josptopen.2024.0087