How to evaluate precisely return to sport after anterior cruciate ligament tear with operative or conservative treatment on patients with moderate sport level?

OBJECTIVE: Several ways exist to assess return to sport (RTS) after anterior cruciate ligament tear (ACLT): main sport or anterior level, pivoting contact sports or competition. Performing a relevant evaluation is difficult especially for moderate level patients. Our objective was to evaluate the reliability of these different outcomes after ACLT; then to assess the concordance between each other.

PATIENTS AND METHODS: Fifty-eight patients with moderate sport level were included (mean age 33.6±12.4 years; 38 men vs. 20 women; 69% of operated, at 17.1±5.3 months; Tegner before injury at 6.3±1.9 vs. 4.9±1.7 after RTS). Return to sport was declarative patients answering yes/no to main sport, previous level, pivoting contact sport, competition. A global level of RTS was measured as the variation of Tegner score and weekly hours of practice before/after ACLT (Tegner score×weekly hours of practice).

RESULTS: Fifty-one percent of patients returned to main sport, 28% to anterior level (of whom 56% to anterior level of main sport), 31% to same global activity level, 19% to competition, 43% to pivoting contact sport. "Tegner.hour score" has decreased by 16.3±33.6 after surgery. There was a strong discordance between declarative RTS and return to similar global activity level with Kappa coefficient respectively of 0.19, 0.17, 0.05 and 0.29 for main sport, previous level, pivoting contact sport, competition.

DISCUSSION/CONCLUSION: We confirmed low RTS rates with a clear discordance between different outcomes of RTS. Considering the global activity volume calculated with Tegner score (Tegner.hour) is an interesting alternative scale to evaluate RTS for moderate sport level patients.