Compliance with Rehabilitation and Return-to-Play Assessments in Patients After Anterior Cruciate Ligament Reconstruction

Abstract

Background Anterior cruciate ligament reconstructions (ACLR) are commonly performed but there is no evidence available on compliance with rehabilitation protocols or the completion of an objective return to sports assessments prior to return to play (RTP) and what effect this may have on ACLR outcomes in our environment. The aim of this study was to assess patient compliance with a rehabilitation programme and return to sports assessment in patients who underwent ACLR and related surgery. The objectives were to: 1) determine the level of compliance with a rehabilitation programme and return to sports assessment, 2) identify the barriers to compliance and motivating factors for increased compliance in these patients, 3) analyse whether certain patient characteristics affect compliance level, 4) describe and compare the RTP rates, re-injury rates and secondary surgery rates between completion of rehabilitation programme and return to play assessment groups. Design The study was conducted using a retrospective patient record review with a prospective recall via an online questionnaire. Results Eighty percent of our participants completed their rehabilitation programme. More than half of the sample completed less than 6 months of their programme and only sixty percent of patients completed a RTP assessment. Most of our participants were motivated by their own desire to reach pre-injury level of activity and by their physiotherapist. Time constraints and lack of funding were cited as the most frequent barriers to rehabilitation. Our RTP rate was calculated to be 90% and when comparing those who returned to ‘some form of sport and the mean time to RTP was 8.88 months. The overall post-surgery Lysholm score vi in this study was 91.02. Overall, the re-injury rates were low. We identified that younger individuals, females and those who had a higher pre-injury Tegner score were more likely to complete more months of their rehab programme. Similarly, younger, and competitive athletes have a higher chance of completing their RTP assessment. We found that RTP rates, re-injury and secondary surgery were not associated with completion of the rehabilitation programme. Subsequent injury of the other knee and RTP rates were associated with completion of the RTP assessment. Conclusion This study is the first to document the compliance with rehabilitation programmes and the completion of return to sports assessments prior to RTP and what effect this may have on ACLR outcomes in the South African context. We have endeavoured to identify barriers to compliance and motivating factors for increased compliance in our patients who have undergone ACLR surgery. The study reviewed multiple return to play variables and identified factors which predict increased compliance.