Confident Athletes More Likely to Experience Second ACL Injury After Return-to-Play

Published January 2022 | Journal of Orthopedic Research

Young athletes who return to sports (RTS) with high confidence in their knees after anterior cruciate ligament (ACL) reconstruction are more likely to experience a second ACL injury within two years, according to research conducted by occupational and physical therapy specialist Mark Paterno, PT, PhD, and colleagues.

The findings, based on data from nearly 160 young athletes, indicate that mental status could play a larger role in safe return-to-play than previously anticipated.

“In all likelihood, these results show us the current return-to-sports criteria really aren’t doing a good job of measuring who’s ready to return to sport,” Paterno says. “They work well in adults, but we’re not seeing the same results in kids. It could be that adolescents typically return to a higher level of play than most adults.”

Strength and functional test scores are currently used to clear an athlete for safe RTS. However, the study results also show that having high confidence increases the risk of ACL re-injury. Findings indicate confident players are twice as likely to experience another injury. The risk spikes to 10 times for confident players who meet all RTS criteria.

“The million-dollar question is how do we intervene for improvement? We want to reach beyond the current RTS tests and identify better measures for successful return to play,” Paterno says. “With that, we could put a tool in the clinician’s hand that would give them a better roadmap to determine if someone is ready to safely return to activity.”

To reach that goal, Paterno’s team is examining different sets of criteria that could provide a more accurate RTS analysis.