Factors influencing return to sports after anterior cruciate ligament reconstruction

Objectives: to assess the frequency of return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR) and to identify factors influencing RTS in individuals from Karachi, Pakistan. Methods: This retrospective cohort study included 109 participants who underwent ACLR between January 2016 and June 2021 at Liaquat National Hospital, Karachi, Pakistan. Patients aged 15–35 years with a pre-injury Tegner Activity Scale score of ≥6, a minimum of 12 months post-surgery, and completed rehabilitation were included. Patients with multi-ligamentous injuries or ACL re-ruptures were excluded. Participants were assessed using the Lysholm/Tegner score, the International Knee Documentation Committee (IKDC) subjective knee evaluation form, and the Tampa Scale for Kinesiophobia (TSK-11) to evaluate pre- and post-injury activity levels, knee function, and kinesiophobia, respectively. Results: Among the 109 participants, 54.1% (n=59) returned to sports at a mean of 9.94±4.73 months post-ACLR; however, only 16.9% (n=10/59) of those who returned were able to achieve pre-injury performance levels. A significant proportion (45.9%, n=50/109) did not return to any level of sports. Those who returned demonstrated significantly higher IKDC (73.76 vs. 67.04, p<0.05) and Lysholm scores (95.45 vs. 85.82, p<0.05), and lower TSK-11 scores (37.44 vs. 44, p<0.05), indicating better knee function and lower kinesiophobia compared to non-RTS individuals. Conclusion: Despite favorable functional outcomes post-ACLR, only half of the participants returned to sports, with an even lower proportion achieving pre-injury performance levels. Elevated kinesiophobia was significantly associated with reduced knee function and activity levels, emphasizing the need to address psychosocial factors in rehabilitation to improve RTS outcomes.