e44 Thursday 16 October Papers / Journal of Science and Medicine in Sport 18S (2014) e23–e71

Award finalist

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Factors associated with anterior knee pain 12months follow hamstring tendon autograft ACLreconstruction

A. Culvenor 1,∗, N. Collins 2, B. Vicenzino 1,J. Cook 3, T. Whitehead 4, H. Morris 2, K. Crossley 1

1 The University of Queensland, Australia2 The University of Melbourne, Australia3 Monash University, Australia4 OrthoSport Victoria, Australia

Introduction: Anterior knee pain (AKP) is a common andtroublesome complication following anterior cruciate ligamentreconstruction (ACLR), irrespective of graft source. While AKP is fre-quently associated with harvest-site morbidity after bone-patellartendon-bone autograft ACLR, factors associated with AKP followingthe common hamstring-tendon (HT) autograft are not known.

Methods: 110 participants (76 males, mean age 30 ± 8 years)were consecutively recruited 12 months following a primary HTautograft ACLR by one of two orthopaedic surgeons. All participantsunderwent assessment of physical performance (hop-for-distance[HFD], cross-over HFD, side-hop and one-leg rise tests) andpatient-reported outcomes including quality of life (QoL) (EQ5D),kinesiophobia (Tampa Scale), activity level (Tegner), return tosport and attitudes related to return to sport (ACL-return to sportindex). Impairments in knee range of movement, laxity, frontalplane alignment and hip external rotation strength were recorded,while injuries to menisci and patellofemoral cartilage were notedintra-operatively. Clinical and physical performance data were nor-malised to the uninjured limb. K-means cluster analysis classifiedparticipants into those with and without AKP using the validatedKujala Patellofemoral Score (0–100). Analysis of variance was usedto evaluate differences between AKP and no AKP groups (p < 0.05).

Results: Thirty-three participants (30%) were defined as hav-ing AKP from the cluster analysis (Kujala score ≤87/100). Thosewith AKP were of older age (mean difference 4.4 years, 95% confi-dence interval 1.0–7.9), had a higher body mass index (2.3 kg m−2,0.7–3.8), performed between 8% and 25% worse on the HFD, cross-over HFD and one-leg rise tests, and had lower activity level (Tegnermedian 4 vs 6). The presence of AKP was also associated with worseQoL, kinesiophobia and return to sport attitudes. No clinical orintra-operative features of AKP were identified.

Discussion: The prevalence of AKP we observed is similar to pre-viously reported rates following HT autograft ACLR. Importantly,our findings reveal that AKP is not simply a trivial complicationfollowing HT harvest. Sports medicine clinicians need to be cog-nisant of AKP in this population as it is associated with worse scoreson both patient-reported outcomes and physical performance. Forthose with AKP following ACLR, rehabilitation protocols shouldinclude a greater focus on weight management education, progres-sion of rehabilitation to high-level activities, including adequatefunctional retraining to optimise confidence and return to sportattitudes. While not being causally determined, these strategiesmay help minimise the high prevalence of AKP and the significantburden it places on this population.

http://dx.doi.org/10.1016/j.jsams.2014.11.243

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Returning to sport after ACL reconstructionvaries according to different physicalfunctioning and contextual factors

C. Ardern 1, N. Taylor 2, J. Feller 3, K. Webster 1,∗

1 School of Allied Health, La Trobe University,Australia2 Department of Physiotherapy, La Trobe University,Melbourne, Australia3 OrthoSport Victoria, Epworth Healthcare,Melbourne, Australia

Introduction: In 2011 we published a systematic review andmeta-analysis of return to sport rates from 48 studies includ-ing over 5500 patients who had anterior cruciate ligament (ACL)reconstruction. This review demonstrated that the return tosport rate following surgery was lower than previously expected,and highlighted the relative lack of emphasis on evaluatingparticipation-based outcomes after ACL reconstruction. Since theoriginal review, returning to sport has received increased researchattention, suggesting that an update to the review was warranted.Therefore, the objectives were to update our original review ofreturn to sport rates following ACL reconstruction, and to add to theoriginal review by investigating the relationship between returningto sport, and aspects of physical functioning and contextual factors.

Methods: Electronic databases were systematically searchedfrom April 2010 to November 2013 for articles reporting the num-ber of patients returning to sport following ACL reconstruction.Return to sport rates, physical functioning, and contextual datawere extracted and combined using random-effects meta-analyses.Data from the original review (studies published up to April 2010)were combined with data from the updated search.

Results: Sixty-nine articles, reporting on 7556 participants werereviewed (48 from the original review and 21 from the updatedsearch). On average, 81% of people returned to some kind of sport,65% returned to their preinjury sport, and 55% returned to com-petitive sport. Symmetrical hopping performance (d = 0.3), youngerage (d = −0.3), male sex (odds ratio = 1.4), playing elite level sport(odds ratio = 2.5), and having a positive psychological response (lowfear of re-injury and greater psychological readiness to return tosport) (d = 0.3) favoured returning to the preinjury sport. Receivinga hamstring tendon autograft favoured returning to competitivesport (odds ratio = 2.4), and receiving a patellar tendon autograftfavoured returning to the preinjury sport (odds ratio = 1.2).

Discussion: Data from over 7000 individuals demonstrated thatone in five people did not return to any sport, one in three did notreturn to their preinjury sport, and one in two did not return tocompetitive sport following ACL reconstruction. Returning to sportvaried according to contextual factors as well as physical function-ing, suggesting that these factors may warrant additional emphasisin post-operative rehabilitation to improve return to sport rates.

http://dx.doi.org/10.1016/j.jsams.2014.11.244