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Biopsychosocial Factors Associated With Return to Preinjury Sport After ACL Injury Treated Without Reconstruction: NACOX Cohort Study 12-Month Follow-up

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posted on 2023-08-18, 01:39 authored by Diane Slater, Joanna Kvist, Clare ArdernClare Ardern
Background: The limited research on prognosis after nonsurgical management of anterior cruciate ligament (ACL) injury has focused on physical factors. We aimed to assess relationships between key patient-reported outcomes, in line with a biopsychosocial approach, and returning to preinjury sport at 12 months after ACL injury treated without reconstruction. Hypothesis: We hypothesized that biopsychosocial factors would be associated with returning to preinjury sport at 12 months after ACL injury. Study Design: Prospective single cohort study. Level of Evidence: Level 2. Methods: Patients who had an ACL injury and did not have reconstruction during the first year after injury were recruited from healthcare clinics in Sweden, and followed up at 3, 6, and 12 months after injury. Return to preinjury sport at 12 months was the primary outcome. Explanatory variables were psychological readiness to return to sport, knee-related quality of life, and self-reported knee function. Using generalized estimating equations, we evaluated the relationships between the explanatory variables and the primary outcome at each timepoint. Results: Data were analyzed for 88 participants with a median age of 27 years (15-40 years). Soccer was the most frequently reported preinjury sport (n = 22). Forty participants (46%) had returned to their preinjury sport at 12 months after ACL injury. The odds of returning to preinjury sport at 12 months increased with higher self-reported knee function at 6 months (odds ratio [OR], 1.1; 95% CI, 1.0-1.1), and the odds of being returned to the preinjury sport at 12 months doubled for every 1-point increase (1-10 scale) in psychological readiness to return to sport measured at 12 months (OR, 1.9; 95% CI, 1.2-3.2). Conclusion: Superior self-reported knee function at 6 months and greater psychological readiness to return to sport at 12 months were associated with returning to the preinjury sport 1 year after ACL injury treated without reconstruction. Clinical Relevance: Consider highlighting the relevance of biopsychosocial factors to returning to preinjury sport after ACL injury when discussing prognosis during shared decision-making.

Funding

The study, as part of the NACOX-cohort study, was supported by the Swedish Medical Research Council (VR 2015-03687 and VR 2018-02563), the Swedish Research Council for Sport Science (CIF P2017-0151, P2018-0132 and P2019-0071), the Medical Research Council of Southeast Sweden (FORSS 662081), and ALF Grants Region Östergötland (LIO-798907, 900721, and 934538).

History

Publication Date

2023-03-01

Journal

Sports Health: A Multidisciplinary Approach

Volume

15

Issue

2

Pagination

9p. (p. 176-184)

Publisher

Sage

ISSN

1941-0921

Rights Statement

© 2022 The Author(s) This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).

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