Adding Self-Directed Psychological Support to Usual Rehabilitation Following Anterior Cruciate Ligament Reconstruction Did Not Increase Return to Sport Rates at 12 Months. Results From the BAck iN the Game (BANG) Randomised Controlled Trial

OBJECTIVES: To evaluate the efficacy of internet-delivered psychological support, the BAck iN the Game (BANG) intervention after anterior cruciate ligament (ACL) reconstruction (ACLR) for improving return to pre-injury sport (RTS). DESIGN: Randomised control trial METHODS: Participants aged 15−30 years, who were playing contact or non-contact pivoting sport at least twice per week prior to ACL injury and intending to return to pivoting sports after ACLR, were included. Participants were randomised to either usual care (UC, standard post-operative treatment) plus the BANG intervention (BANG+UC group) or usual care alone (UC group). The intervention was a 24-week internet-delivered psychological support program, co-designed with athletes and clinicians, and based on cognitive-behavioural therapy principles. Participants reported sports participation fortnightly after ACLR and functional and psychological outcomes at 3-, 6-, and 12 months. Knee function was measured at 12 months after ACLR. New injuries were registered up to 24 months after ACLR. The primary outcome was RTS at 12 months follow-up. RESULTS: 161 participants were included, 80 in BANG+UC group and 81 in the UC group. The RTS rate at 12 months was 36% in both groups with no significant differences in the proportion who RTS (risk ratio [RR], 1.01; 95% CI, 0.59–1.73; p = 0.971) or in functional and psychological outcomes. Twelve participants sustained new ACL injuries (6 in each group), with no between-group differences. CONCLUSIONS: There was no effect of internet-delivered psychological support on the RTS rate, readiness to RTS or subsequent knee injuries beyond usual postoperative care for people with ACLR.