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Purpose For a successful return to sport (RTS) after an anterior cruciate ligament reconstruction (ACLR), patients are recommended to attend a comprehensive rehabilitation program, followed by an RTS assessment, that is a combination of tests. The purpose of this study was to predict a successful return to sport using the results of the RTS assessment and self-reported questionnaires at minimum 2 years after ACLR. Methods A total of 123 consecutive ACLR patients undertook an intensive rehabilitation program followed by a comprehensive RTS assessment that included an established combination of balance and strength tests, the ACL-return to sport after Injury scale (ACL-RSI) questionnaire and a KT1000 laximetry test. Preinjury and expected Tegner and Lysholm were collected at baseline, at RTS and prospectively collected at minimum 2-year follow-up. The patients were asked if they returned to their previous sport and at which level. All variables were included in a regression analysis predicting a successful return to previous sport, return to the same level of sport as well as the Tegner level at 2 years. Results Sixty-two patients (50%) returned to their previous sport by the 2-year follow-up, without a difference in preinjury Tegner between these two groups (n.s.). Expected preoperative Tegner was the only significant predictor of a successful return to previous sport ( p  = 0.042; OR 1.300, 95% CI 1.010–1.672). Out of the 62 patients returning to their previous sport, 38 (61%) reported to be on the same or higher level. The only predictive variable for returning to the same level was the higher preinjury Tegner level ( p  = 0.048; OR 1.522). Multivariate regression analysis of Tegner level at 2 years found younger age to be the only predictive value. From the RTS assessment tests, the ACL-RSI questionnaire and the posterolateral balance test were predictive variables for Tegner at 2-year follow-up, albeit in the univariate regression analysis. Conclusions Preoperative Tegner and expected Tegner level collected prior to an ACL reconstruction can aid in the objective prediction of patients’ return to sport after 2 years. High-level athletes are more likely to return to their previous sport and to the previous level. Younger patients achieve a higher Tegner level at 2 years. Level of evidence Level III study.

Purpose To determine factors that predict return to the same frequency and type of sports participation with similar activity demands as before injury. Methods Individuals 1 to 5 years after primary ACL reconstruction completed a comprehensive survey related to sports participation and activity before injury and after surgery. Patient characteristics, injury variables, and surgical variables were extracted from the medical record. Return to preinjury sports (RTPS) was defined as: “Returning to the same or more demanding type of sports participation, at the same or greater frequency with the same or better Marx Activity Score as before injury.” Variables were compared between individuals that achieved comprehensive RTPS and those that did not with univariate and multivariate logistic regression models. Results Two-hundred and fifty-one patients (mean age 26.1 years, SD 9.9) completed the survey at an average of 3.4 years (SD 1.3) after ACL reconstruction. The overall rate of RTPS was 48.6%. Patients were more likely to RTPS if they were younger than 19 years old (OR = 4.07; 95%CI 2.21–7.50; p  < 0.01) or if they were competitive athletes (OR = 2.07; 95%CI 1.24–3.46; p  = 0.01). Patients were less likely to RTPS if surgery occurred more than 3 months after injury (OR = 0.31, 95%CI 0.17–0.58; p  < 0.01), if there was a concomitant cartilage lesion (OR = 0.38; 95%CI 0.21–0.70; p  < 0.01), and if cartilage surgery was performed (OR = 0.17; 95%CI 0.04–0.80; p  = 0.02). Conclusion Five variables best predicted RTPS including age at time of surgery. Only time from injury to surgery is a potentially modifiable factor to improve RTPS; however, the reasons for which patients delayed surgery may also contribute to them not returning to sports. Regardless, younger patients, those that partake in sports on a competitive level, those that undergo surgery sooner, or do not have a cartilage injury or require cartilage surgery are more likely to return to pre-injury sports participation. Level of evidence III.

Purpose Recurrent patellar dislocation is a frequent knee disorders in young, active patients. Medial patellofemoral ligament reconstruction (MPFLR) can restore knee stability and function, but the rate of return to sports is less clear. The aim of this study was to evaluate rate of return to sport following treatment of recurrent patellar dislocation with isolated MPFLR. Methods Between 2011 and 2018, 113 patients with recurrent patellar dislocation were treated with isolated MPFLR at an academic center. Pre-injury sports participation and Tegner score, pre-operative subjective IKDC score, time to return to sports, and post-operative Tegner and subjective IKDC scores were collected, with a minimum of follow-up of 2 years. Results One hundred and three patients (91%) were evaluated at a mean of 4.5 ± 2.5-year post-operative. 92 patients (89%) participated in sports prior to onset of patellar instability. At final follow-up, 84 of these 92 patients (91%) were able to return to sports. The mean time from surgery to return to sports was 10.4 ± 8.6 months (range: 2–48 months). 62 patients (67%) returned to the same (50 patients) or higher (12 patients) level. 22 patients (26%) returned at a lower level. 19 of these patients attributed this decreased participation to ongoing knee problems. The median Tegner score was noted to decrease from 5 pre-injury to 4 post-operatively ( p  = 0.02). Conclusion Isolated MPFL reconstruction allowed return to pre-injury sports in 91% of patients, with 67% of patients returning to the same or higher level than pre-injury. Mean time to return to sports was 10 months and post-operative Tegner score was noted to be modestly decreased from pre-injury level. Level of evidence IV.

Attention-deficit/hyperactivity disorder (ADHD) has been speculated to prolong concussion recovery; however, the evidence regarding concussion recovery for individuals with ADHD is limited. To examine the concussion recovery time based on ADHD status, sex, and age. Cross-sectional study. High school. Nine hundred and thirty-five (female: n = 382, 40.1%) concussions, including 78 (female: n = 13, 20.0%) self-identified ADHD data, were analyzed. A Poisson regression was used to estimate the return-to-learn and return-to-sport recovery outcomes with 3 predicting variables: ADHD status, sex, and age. The mean return-to-learn days of the ADHD and non-ADHD groups were 12.86 ± 10.89 (median = 11.0; interquartile range [IQR] = 8.0; 7.0-15.25) and 1.43 ± 8.39 (median = 9.0; IQR = 9.0; 6.0-14.0), respectively. The mean return-to-sport days of the ADHD and non-ADHD groups were 20.82 ± 15.25 days (median = 17.0; IQR = 9.0; 12.0-21.0) and 18.03 ± 11.42 days (median = 15.0; IQR = 10.0; 11.0-21.0), respectively. For return-to-learn, ADHD status (risk ratio [RR] = 1.16; 95% confidence interval [95% CI]: 1.08, 1.24; P < .001) and female sex (RR = 1.13; 95% CI: 1.08, 1.17; P < .001) were significant variables for longer recovery, whereas age was not (RR = 0.995; 95% CI: 0.98, 1.01; P = .056). For return to sport, ADHD status (RR = 1.17; 95% CI: 1.12, 1.23; P < .001), female sex (RR = 1.07; 95% CI: 1.04, 1.11; P < .001), and younger age (RR = 0.98; 95% CI: 0.96, 0.99; P < .001) were all significant variables for longer recovery. Health care providers must be aware of the elevated risk of prolonged concussion recovery among high school athletes with ADHD.

Background Avulsion fractures of the pelvic apophyses typically occur in adolescent athletes due to a sudden strong muscle contraction while growth plates are still open. The main goals of this systematic review with meta-analysis were to summarize the evidence on clinical outcome and determine the rate of return to sports after conservative versus operative treatment of avulsion fractures of the pelvis. Methods A systematic search of the Ovid database was performed in December 2016 to identify all published articles reporting outcome and return to preinjury sport-level after conservative or operative treatment of avulsion fractures of the pelvis in adolescent patients. Included studies were abstracted regarding study characteristics, patient demographics and outcome measures. The methodological quality of the studies was assessed with the Coleman Methodology Score (CMS). Results Fourteen studies with a total of 596 patients met the inclusion criteria. The mean patient age was 14.3 ± 0.6 years and 75.5% of patients were male. Affected were the anterior inferior iliac spine (33.2%), ischial tuberosity (29.7%), anterior superior iliac spine (27.9%), iliac crest (6.7%) lesser trochanter (1.8%) and superior corner of the pubic symphysis (1.2%). Mean follow-up was 12.4 ± 11.7 months and most of the patients underwent a conservative treatment (89.6%). The overall success rate was higher in the patients receiving surgery (88%) compared to the patients receiving conservative treatment (79%) ( p =  0,09). The rate of return to sports was 80% in conservative and 92% in operative treated patients ( p =  0,03). Overall, the methodological quality of the included studies was low, with a mean CMS of 41.2. Conclusion On the basis of the present meta-analysis, the overall success and return to sports rate was higher in the patients receiving surgery. Especially in patients with fragment displacement greater 15 mm and high functional demands, surgical treatment should be considered.

IntroductionUnicompartmental knee arthroplasty (UKA) is frequently performed on active patients with symptomatic osteoarthritis who desire a quick return to sports. The aim of this study was to compare return to sport after lateral UKA performed by robotic-assisted and conventional techniques.Materials and methodsThis retrospective study has assessed 28 lateral UKA (25 patients), 11 performed with robotic-assisted technique and 17 with conventional technique, between 2012 and 2016. The mean age was 65.5 and 59.5 years, with a mean follow-up of 34.4 months (range 15–50) and 39.3 months (range 22–68). Both groups were comparable pre-operatively. Sport habits and the details of the return to sports were assessed using University of California, Los Angeles Scale (UCLA) and direct questioning.ResultsRobotic-assisted surgical technique provided significantly quicker return to sports than conventional technique (4.2 ±1.8 months; range 1–6 vs 10.5 ± 6.7 months; range 3–24; p < 0.01), with a comparable rate of return to sports (100% vs 94%). The practiced sports after lateral UKA were similar to those done preoperatively, with mainly low- and mid-impact sports (hiking, cycling, swimming, and skiing).ConclusionRobotic-assisted lateral UKA reduces the time to return to sports at pre-symptomatic levels when compared with conventional surgical technique. The return to sports rate after surgery is high in both groups. A long-term study would provide data on the prothesis wear in this active population.Level of evidenceComparative retrospective study, Level III.

Purpose This study aimed to investigate preoperative sports participation and postoperative clinical outcomes including a return to sports (RTS) after hybrid closed-wedge high tibial osteotomy (CWHTO) for medial compartment osteoarthritis of the knee. Characteristic of Hybrid CWHTO was defined as extra-articular lateral closed and medial open wedge osteotomy. Methods The patients who underwent hybrid CWHTO from January 2016 to December 2018 were retrospectively reviewed and divided them into sports and non-sports groups. The preoperative demographic and radiographic characteristics were compared in both groups. And the clinical outcomes including the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS), Lysholm score, University of California at Los Angeles (UCLA) activity score, and RTS in the sports group were also investigated. Statistical analysis was performed for comparisons among the preoperative factors between the two groups. Influence of sports impact and bone union of fibular osteotomy was also statistically investigated for RTS. Results Of the 161 knees (129 patients; 46 males, 83 females), 20 knees (16 patients; 13 males, 3 females; 12.3%) belonged to sports group. Although there were no significant differences regarding the age and radiographic parameters, there were significant differences in the body mass index and proportion of males between both groups. The JOA, VAS, Lysholm, and UCLA activity scores significantly improved after surgery. RTS was 80% at a mean duration of 7.2 ± 3.1 months. RTS in the high-impact sports group was significantly lower than that in the low-impact sports group (high-impact 60% vs. low-impact 100%, p = 0.043). There was no significant difference in RTS regarding bone union after fibular osteotomy. Conclusion The clinical outcomes including RTS were satisfactory in patients with hybrid CWHTO. Level of evidence IV.

Purpose The aim of this study was, to investigate the rate of return to sports (RTS) and physical activity after implantation of PFIA and to identify factors predictive of improved postoperative sporting ability. Methods Sixty-two patients with a mean age of 46 ± 11 years, who underwent implantation of PFIA at the senior authors’ institution, were enrolled. They were prospectively evaluated preoperatively and at a minimum of 2 years postoperatively with a mean follow-up of 60 ± 25 months. Clinical outcomes, return to sports and activity, type of sport or activity, subjective satisfaction, and frequency were evaluated by questionnaire. Results The transformed overall Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score improved from 67 ± 16 to 77 ± 19 ( p =  0.003), Tegner activity scale results improved from 3 ± 2 points to 4 ± 1 points ( p  < 0.001), and scores on the visual analog scale (VAS) pain scale decreased from 6 ± 2 points to 3 ± 2 points ( p  < 0.001). The sports frequency increased from 1 ± 2 sessions to 2 ± 1 sessions per week ( p  = 0.001). Ninety-four percent of the patients who did not fail could return to the same or higher level of sports, with 74% of the patients reporting an improved ability to perform sports. No preoperative factors could be detected to significantly influence RTS after surgery. Conclusions PFIA is a valid treatment option for the active patient with end-stage isolated patellofemoral OA. Reliable improvements in knee function, pain, and participation in low-impact sports were found. Level of evidence IV.

Purpose The purpose of this systematic review was to evaluate the rate at which patients return to sport following arthroscopic hip surgery. Methods The databases MEDLINE, EMBASE, and PubMed were searched by two reviewers, and titles, abstracts, and full-text articles screened in duplicate. English language studies investigating hip arthroscopy with reported return to sport outcomes were included. A meta-analysis of proportions was used to combine the rate of return to sports using a random effects model. Results Overall, 38 studies with 1773 patients (72% male), with a mean age of 27.6 years (range 11–65) and mean follow-up of 28.1 months (range 3–144) were included in this review. The pooled rate of return to sport was: 93% [95% confidence interval (CI) = 87–97%] at any level of participation; 82% (95% CI = 74–88%) at preoperative level of sporting activity; 89% (95% CI = 84–93%) for competitive athletes; 95% (95% CI = 89–98%) in pediatric patients; and 94% (95% CI 89.2–98.0%) in professional athletes. There was significant correlation between a shorter duration of preoperative symptoms and a higher rate of return to sports (Pearson correlation coefficient = − 0.711, p  = 0.021). Conclusion Hip arthroscopy yields a high rate of return to sport, in addition to marked improvement in pain and function in the majority of patients. The highest rates of return to sport were noted in pediatric patients, professional athletes, and those with a shorter duration of preoperative symptoms. This study provides clinicians with evidence-based data on athletes’ abilities to return to sport after arthroscopic hip surgery and identifies sub-populations with the highest rates of return to sport. Level of evidence IV, systematic review of Level II–IV studies.

Purpose The aim of this study was to evaluate return to sports after arthroscopic Bankart stabilization. Methods This is a retrospective study including all athletes aged <50 years who underwent arthroscopic stabilization in 2010 and 2011 (m, 36; f, 10; mean age 28.9 ± 8.1 years; follow-up 24.4 ± 7.7 months). Sixteen patients were practicing competitive sports and 30 recreational sports. Level and delay of return to sports, sports classification according to Allain, Western Ontario Shoulder Instability Index (WOSI) score, patient satisfaction, apprehension level and avoidance behaviour were noted. Results 95.7 % returned to the same level after an average of 9.8 ± 5.4 months. Sports level was unchanged or better in 82.6 %, lower in 8.7, and 4.5 % changed sport because of their shoulder. Patients with more than 10 dislocations returned to sports and to their preoperative level later than patients with <10. Male athletes returned to preoperative sports levels faster than female athletes ( p  < 0.001). The WOSI score and also its item “sports” were worse in those who had not returned ( p  = 0.0002 and 0.006, respectively). Satisfaction correlated with the WOSI score ( p  = 0.0004) while 93.3 % were satisfied/very satisfied. The decrease in the apprehension level was significant ( p  < 0.00001). 36.9 % still experienced avoidance behaviour. Conclusions Most athletes resumed their main sport often at the same level, but the threshold of 10 dislocations should be considered a risk factor for longer return to sports at any level. The WOSI score is a valuable outcome score after Bankart stabilization. Postoperative avoidance should be distinguished from apprehension. Level of evidence IV.