Return to play following ACL reconstruction: survey among experienced arthroscopic surgeons (AGA instructors)

There is a lack of consensus regarding appropriate criteria attesting patient’s unrestricted sports activities after ACL reconstruction. The purpose of this study was to perform a survey among experienced arthroscopic surgeons regarding their return to play guidelines in these patients.

A six-item questionnaire was distributed among experienced arthroscopic surgeons (instructors of the German speaking society of arthroscopy, AGA). Study participants were asked to choose from multiple choice answers and had the possibility answering in an open discussion field.

The response rate of the survey was 85.7 %. A total of 83.5 % used autologous hamstring grafts for ACL reconstruction in athletes followed by BPTB (37.2 %) and quadriceps tendon graft (12 %). Approximately 63.5 % recommended a time point later than 6 months allowing return to play after ACL reconstruction in the athlete (after 4 and 6 months 2.3 and 35.3 %, respectively). 76.6 % recommended starting with sports specific rehabilitation after 4 months (21.6 % after 6 months). The most frequent criterion (multiple answers) to allow return to play was negative Lachman test (81.7 % positive answers) followed by free range of motion (78.4 %), negative pivot shift (60.1 %), anterior drawer (45.4 %), proprioception test (43.1 %), muscular strength analysis (40.8 %), single-leg hop jump test (39.0 %), KT 1000 measurement (16.1 %), and MRI (4.1 %). Of the surgeons 85.8 % did not use any of the given scores as criterion to allow return to competitive sports (subjective IKDC score 10.6 %, Lysholm score 8.3 %, objective IKDC score 7.4 %, Tegner activity scale 3.7 %).

In conclusion, the majority of surgeons do not consider muscle function, jump tests, alignment tests, and proprioception as relevant return to sports criterion. However, these are two crucial parameters for return to sports.