Return-to-sport tests: Do they reduce risk of re-rupture after anterior cruciate ligament reconstruction?

Introduction: Anterior cruciate ligament (ACL) rupture is one of the most common knee injuries. Despite the effectiveness of reconstruction, re-rupture rates of up to 15 % have been reported. Static and dynamic test of strength and movement control have been used to determine when return to sports (RTS) is appropriate. Objective: To determine whether successfully passing return to sport (RTS) tests reduces the re-rupture rate. Methods: Retrospective cohort study. Patients who underwent ACL reconstruction (ACLR) from June 2018 to May 2023, and who performed RTS tests after rehabilitation, were analyzed. Patients who, in addition to ACLR, underwent extra-articular tenodesis, osteotomy, or multiligament injuries were excluded. RTS tests included the following: repeat sprint ability, dynamic valgus, proagility, unilateral counter movement jump (CMJ), isokinetic, triple hop test, and functional movement screen (FMS). All statistical analyses were performed with STATA version 18.0. Results: Ninety five patients underwent RTS tests after ACLR, with a follow-up time of 27.8 months. 71.6 % of patients were men with a mean age of 25.15 + 10.7 years. The overall re-rupture rate was 13.68 % (13 patients). When comparing patients who passed and did not pass the RTS tests, there were no differences by sex (p = 0.06) or age (p = 0.11). The only statistically significant difference between the groups was the mean risk score (passed: 11.5 + 0.7 vs. not passed: 15.5 + 2.1; p < 0.001). Patients with re-rupture were more likely to be from the non-passed group (passed: 0% v/s not passed: 18.1 %; p = 0.03), with a statistical power of 0.70. Conclusion: Our records show that passing RTS test after an ACLR could guarantee the absence of re-rupture in the medium term. Level of evidence: Level IV.