Despite the fact we see professional athletes suffer ACL tears and return to play, we have seen evidence that weekend warriors might not do as well. For example, some studies show rates of return to sports at one year after ACL reconstruction between 78% and 98% among professional athletes. On the other hand, some studies looking at amateur athletes showed return to sports rates less than 50%.

It’s important to understand what happens to the athletes who haven’t returned to sports one year after surgery. Do they ever get back to play? If they do, are they as good as they were before they got hurt?

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Video: ACL reconstruction surgery
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Is there hope for athletes who haven’t returned by 1 year?

A study published online ahead of print in the American Journal of Sports Medicine attempted to answer those questions. Clare L. Ardern and a team of researchers published a previous study of 187 competitive athletes (none were professional or elite). 122 of them had not returned to their preinjury level of sports by one year. They followed these 122 athletes after one year to see how many of them ultimately did return to sports.

They found some important information on amateur athletes after ACL reconstruction:

• 91% of the athletes ultimately returned to play sports at some level between one and two years after surgery.
• By two years after surgery, 66% were playing sports. Only 41% were playing sports at their preinjury levels. 25% were playing a lower level.
• Athletes for whom this was their first ACL reconstruction were four times more likely to return to preinjury levels of play than those athletes who had undergone ACL reconstruction on either knee previously.
• Athletes who had returned to preinjury levels scored better on self-motivation questions. They scored higher on questions about the possibility of returning to play, the importance of returning, and the time and effort they were willing to invest.

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Three risk factors for a second ACL injury
Reinjury more likely among athletes after ACL surgery
Allograft ACL reconstructions might have higher failure rates

Take home points

This study offers information important to the injured athlete as well as the surgeons and physical therapists who treat them. Most importantly, this data suggests that even though amateur athletes often don’t return to play within 12 months of surgery, they often return between one and two years after surgery.

Patients who had previously undergone ACL reconstruction on that same knee or the opposite one were far less likely to return to preinjury levels than those for whom it was their first ACL surgery. Surgeons might set the expectation of these patients before surgery. Counseling them on the challenges of returning to preinjury levels so that they can plan to work hard in physical therapy for a year or more might be helpful.

Finally, there appears to be a relationship between a patient’s psychological state one year after surgery and the chances of ultimately returning to play. Identifying athletes who value returning to sports and who will work hard to achieve that goal is important for doctors and therapists. If an athlete exhibits signs of struggling, healthcare providers might suggest working with a sports psychologist or encouraging them in other ways.

Also read:
ACL injuries and deciding when to have surgery
Neuromuscular training programs can prevent ACL injuries and save money
3 less known reasons athletes don’t return after ACL injuries

Do these number surprise you? Why do you feel amateur athletes have trouble returning to their same level of play as before they got hurt? I’d love to hear your thoughts!

Reference:
Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Sports Participation 2 Years After Anterior Cruciate Ligament Reconstruction in Athletes Who Had Not Returned to Sport at 1 Year: A Prospective Follow-up of Physical Function and Psychological Factors in 122 Athletes. Am J Sports Med. Published online January 12, 2015.