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Editorial| Volume 39, ISSUE 3, P571-574, March 2023

Return-to-Sport Outcomes After Anterior Cruciate Ligament Surgical Treatment May Be Improved by Attention to Modifiable Factors and Consideration of Nonmodifiable Factors

DOI:https://doi.org/10.1016/j.arthro.2022.12.003
Return-to-Sport Outcomes After Anterior Cruciate Ligament Surgical Treatment May Be Improved by Attention to Modifiable Factors and Consideration of Nonmodifiable Factors
Next ArticleRegarding “Bubble Sign: An Arthroscopic Technical Trick to Differentiate Between Partial- and Full-Thickness Rotator Cuff Tears”

      Abstract

      Today, we who treat athletes are able to effect immediate, significant improvement in anterior cruciate ligament (ACL) patient outcomes, regardless of surgical technique, by careful determination of when an athlete is ready to return to sport. “Prehabiliation,” bracing, time after surgery to various rehabilitation activities, time after surgery until return to sport, functional testing, strength testing including limb symmetry indices, psychological readiness, age, gender, and type of sport are all factors influencing successful return to sport after ACL injury and treatment. Age and gender are not modifiable, and for some athletes, type of sport may be nonnegotiable. However, each of these factors could be thoughtfully considered before returning an athlete to sport after ACL treatment. All the other factors listed above, from prehab to bracing to strength to psychological readiness, may be modifiable.
      Since the inception of Arthroscopy, the anterior cruciate ligament (ACL) has always been a topic of passionate interest among our readers. Looking back, most of the articles on the ACL have focused on refinement of technique: how to perform better ACL reconstructive surgery and, from time to time, how to perform better ACL primary repair. Of course, how to perform better surgery is measured by results, and continuing to look back, the methods for reporting our results or outcomes after ACL treatment evolved slowly over a long period of time but seem to be evolving more rapidly today.
      Historically, ACL outcome measures focused on failure rates or on knee stability as measured by the surgeon. From our point of view, and more importantly from the patient’s point of view, while failure is the paramount poor outcome, knee stability as measured by the surgeon is of less importance. In terms of stability, what matters to the patient is whether their knee buckles or, focusing on the positive, whether their knee “feels” stable. And, while a feeling of stability may correlate with laxity as measured by an anterior drawer or Lachman’s test, there are definitely patients whose knees feel stable on physical examination who complain of buckling, as well as patients whose knees feel disconcertingly loose on examination but have no complaints of instability.
      Thus, over time, clinicians and researchers have turned our attention to patient-reported outcome measures (PROMs). Initially, PROMs included both general health measures and joint-specific (i.e., knee) or condition-specific (i.e., ACL) measures. However, similar to the discussion above, there are definitely patients with “excellent” ACL PROM scores, who are dissatisfied, and vice versa. As a result, as discussed in last month’s editorial, lately, we have further refined our emphasis and focused on questions that are essentially important to patients such as, “Are you satisfied with the result of your treatment? Are you substantially improved? Are you (or is your knee) back to normal?”
      • Rossi M.J.
      • Brand J.C.
      • Lubowitz J.H.
      Minimally clinically important difference (MCID) is a low bar.
      Arthroscopy. 2023; 39: 139-141
      For athletes, return to sport and, ideally, return to sport at the same level determines satisfaction. Today, this too has become a primary focus of the ACL literature. The purpose of this editorial, for readers who were starting to wonder, is to bring attention to 2 articles in the current issue of Arthroscopy that focus on return to sport after ACL reconstruction. Readers who treat patients with ACL injury will benefit from careful review of these articles, because we believe with a high degree of certainty that the knowledge presented represents an opportunity to immediately and significantly improve ACL patient outcomes. We thus highly recommend “There Is Substantial Variation in Rehabilitation Protocols Following Anterior Cruciate Ligament Reconstruction: A Survey of 46 American Orthopaedic Surgeons”
      • Glattke K.E.
      • Tummala S.V.
      • Goldberg B.
      • Menzer H.
      • Chhabra A.
      There is substantial variation in rehabilitation protocols following anterior cruciate ligament reconstruction: A survey of 46 american orthopaedic surgeons.
      Arthroscopy. 2023; 39: 578-589
      by Glattke et al., accompanied by an insightful Editorial Commentary by Lin.
      • Lin T.
      Editorial commentary: There is no standard for or standardization of postoperative rehabilitation protocols after anterior cruciate ligament reconstruction.
      Arthroscopy. 2023; 39: 590-591
      We also highly recommend “Critical Criteria Recommendations: Return to Sport After Anterior Cruciate Ligament Reconstruction Requires Evaluation of Time after Surgery of 8 Months, >2 Functional Tests, Psychological Readiness, and Quadriceps/Hamstring Strength” by Turk et al.
      • Turk R.
      • Shah S.
      • Chilton M.
      • et al.
      Critical criteria recommendations: Return to sport after anterior cruciate ligament reconstruction requires evaluation of time after surgery of 8 months, >2 functional tests, psychological readiness, and quadriceps/hamstring strength.
      Arthroscopy. 2023; 39: 790-801
      Readers, and particularly future authors, who wish to learn more will find related relevant articles in Arthroscopy
      • Barber-Westin S.D.
      • Noyes F.R.
      Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction.
      Arthroscopy. 2011; 27: 1697-1705
      , 
      • Flanigan D.C.
      • Everhart J.S.
      • Pedroza A.
      • Smith T.
      • Kaeding C.C.
      Fear of reinjury (kinesiophobia) and persistent knee symptoms are common factors for lack of return to sport after anterior cruciate ligament reconstruction.
      Arthroscopy. 2013; 29: 1322-1329
      , 
      • Fabricant P.D.
      • Chin C.S.
      • Conte S.
      • Coleman S.H.
      • Pearle A.D.
      • Dines J.S.
      Return to play after anterior cruciate ligament reconstruction in major league baseball athletes.
      Arthroscopy. 2015; 31: 896-900
      , 
      • Takazawa Y.
      • Ikeda H.
      • Saita Y.
      • et al.
      Return to play of rugby players after anterior cruciate ligament reconstruction using hamstring autograft: Return to sports and graft failure according to age.
      Arthroscopy. 2017; 33: 181-189
      , 
      • Tay K.S.
      • Tan A.H.C.
      Clinical outcomes, return to sports, and patient satisfaction after anterior cruciate ligament reconstruction in young and middle-aged patients in an Asian population—A 2-year follow-up study.
      Arthroscopy. 2018; 34: 1054-1059
      , 
      • Okoroha K.R.
      • Fidai M.S.
      • Tramer J.S.
      • et al.
      Length of time between anterior cruciate ligament reconstruction and return to sport does not predict need for revision surgery in National Football League players.
      Arthroscopy. 2019; 35: 158-162
      , 
      • Glogovac G.
      • Adam P.
      • Schumaier A.P.
      • Brian M.
      • Grawe B.M.
      Return to sport following revision anterior cruciate ligament reconstruction in athletes: A systematic review.
      Arthroscopy. 2019; 35: 2222-2230
      , 
      • Wright R.W.
      Editorial commentary: Return to play following revision anterior cruciate ligament reconstruction.
      Arthroscopy. 2019; 35: 2231-2232
      , 
      • Nyland J.
      • Taniyama D.
      Editorial commentary: Rehabilitation and return-to-sports readiness, the “black box” of anterior cruciate ligament reconstruction patient recovery.
      Arthroscopy. 2019; 35: 2080-2082
      , 
      • Webster K.E.
      • Hewett T.E.
      Is there value and validity for the use of return to sport test batteries after anterior cruciate ligament injury and reconstruction?.
      Arthroscopy. 2020; 36: 1500-1501
      , 
      • Springer B.
      • Bechler U.
      • Koller U.
      • Windhager R.
      • Waldstein W.
      Online videos provide poor information quality, reliability, and accuracy regarding rehabilitation and return to sport after anterior cruciate ligament reconstruction.
      Arthroscopy. 2020; 36: 3037-3047
      , 
      • Hurley E.T.
      • Manjunath A.K.
      • Strauss E.J.
      • Jazrawi L.M.
      • Alaia M.J.
      Return to play following anterior cruciate ligament reconstruction with extra-articular augmentation: A systematic review.
      Arthroscopy. 2021; 37: 381-387
      , 
      • Getgood A.
      Editorial commentary: Return to sport following extra-articular augmentation of anterior cruciate ligament reconstruction—let the LET (lateral extra-articular tenodesis) games commence!.
      Arthroscopy. 2021; 37: 388-390
      , 
      • Beletsky A.
      • Naami E.
      • Lu Y.
      • et al.
      The patient acceptable symptomatic state in primary anterior cruciate ligament reconstruction: Predictors of achievement.
      Arthroscopy. 2021; 37: 600-605
      , 
      • Leonard J.P.
      Editorial commentary: Preoperative exercise, Workers’ Compensation, diabetes, lateral extra-articular tenodesis, and return to sport determine patient satisfaction after anterior cruciate ligament reconstruction.
      Arthroscopy. 2021; 37: 606-608
      , 
      • Jeffers K.W.
      • Shah S.A.
      • Calvert D.D.
      • et al.
      High return to play and low reinjury rates in National Collegiate Athletic Association Division I football players following anterior cruciate ligament reconstruction using quadrupled hamstring autograft.
      Arthroscopy. 2022; 38: 99-106
      , 
      • Matzkin E.
      Editorial commentary: Large-diameter quadrupled hamstring autografts are an acceptable option for National Collegiate Athletic Association Division I college football players: We must challenge our comfort zone to be successful in the end zone.
      Arthroscopy. 2022; 38: 107-108
      , 
      • Piussi R.
      • Beischer S.
      • Thomeé R.
      • et al.
      Greater psychological readiness to return to sport, as well as greater present and future knee-related self-efficacy, can increase the risk for an anterior cruciate ligament re-rupture: A matched cohort study.
      Arthroscopy. 2022; 38: 1267-1276.e1
      , 
      • Webster K.E.
      Editorial commentary: Why the mind matters in anterior cruciate ligament injury recovery: Psychological readiness and return to sport.
      Arthroscopy. 2022; 38: 1277-1278
      , 
      • Schaffer J.C.
      • Kuhns B.
      • Reuter J.
      • et al.
      Clinically depressed patients having anterior cruciate ligament reconstruction show improved but inferior rate of achieving minimum clinically important difference for patient-reported outcomes measurement information system compared with situationally depressed or nondepressed patients.
      Arthroscopy. 2022; 38: 2863-2872
      , 
      • Nwachukwu B.U.
      Editorial commentary: Clinically depressed patients show worse outcomes after anterior cruciate ligament reconstruction than situationally depressed patients and patients without mood issues.
      Arthroscopy. 2022; 38: 2873-2874
      ; Arthroscopy, Sports Medicine, and Rehabilitation (ASMAR),
      • Burgess C.J.
      • Stapleton E.
      • Choy K.
      • Iturriaga C.
      • Cohn R.M.
      Decreased performance and return to play following anterior cruciate ligament reconstruction in National Football League wide receivers.
      Arthrosc Sports Med Rehabil. 2021; 3: e455-e461
      , 
      • Khalil L.S.
      • Lindsay-Rivera K.G.
      • Abbas M.J.
      • et al.
      Game utilization and performance following RTP from ACL reconstruction does not influence a subsequent second ACL injury in national football league players.
      Arthrosc Sports Med Rehabil. 2021; 3: e1377-e1385
      , 
      • Abbas M.J.
      • Khalil L.S.
      • Rahman T.
      • et al.
      Anterior cruciate ligament reconstruction does not impact career earnings after return to play in National Basketball Association athletes.
      Arthrosc Sports Med Rehabil. 2021; 3: e1491-e1497
      , 
      • Betsch M.
      • Hoit G.
      • Dwyer T.
      • et al.
      Postoperative pain is associated with psychological and physical readiness to return to sports one-year after anterior cruciate ligament reconstruction.
      Arthrosc Sports Med Rehabil. 2021; 3: e1737-e1743
      , 
      • Coquard C.
      • Carrozzo A.
      • Saithna A.
      • et al.
      Anterolateral ligament reconstruction does not delay functional recovery, rehabilitation, and return to sport after anterior cruciate ligament reconstruction: a matched-pair analysis from the SANTI (Scientific ACL Network International) study group.
      Arthrosc Sports Med Rehabil. 2022; 4: e9-e16
      , 
      • Cunha J.
      • Solomon D.J.
      ACL prehabilitation improves postoperative strength and motion and return to sport in athletes.
      Arthrosc Sports Med Rehabil. 2022; 4: e65-e69
      , 
      • Cognetti D.J.
      • Sheean A.J.
      • Owens J.G.
      Blood flow restriction therapy and its use for rehabilitation and return to sport: Physiology, application, and guidelines for implementation.
      Arthrosc Sports Med Rehabil. 2022; 4: e71-e76
      , 
      • Gokeler A.
      • Dingenen B.
      • Hewett T.E.
      Rehabilitation and return to sport testing after anterior cruciate ligament reconstruction: Where are we in 2022?.
      Arthrosc Sports Med Rehabil. 2022; 4: e77-e82
      , 
      • Draovitch P.
      • Patel S.
      • Marrone W.D.
      • et al.
      The return-to-sport clearance continuum is a novel approach toward return to sport and performance for the professional athlete.
      Arthrosc Sports Med Rehabil. 2022; 4: e93-e101
      , 
      • Badawy C.R.
      • Jan K.
      • Beck E.C.
      • et al.
      Contemporary principles for postoperative rehabilitation and return to sport for athletes undergoing anterior cruciate ligament reconstruction.
      Arthrosc Sports Med Rehabil. 2022; 4: e103-e113
      , 
      • Waldron K.
      • Brown M.
      • Calderon A.
      • Feldman M.
      Anterior cruciate ligament rehabilitation and return to sport: How fast is too fast?.
      Arthrosc Sports Med Rehabil. 2022; 4: e175-e179
      , 
      • Fares M.Y.
      • Khachfe H.H.
      • Salhab H.A.
      • Bdeir A.
      • Fares J.
      • Baydoun H.
      Physical testing in sports rehabilitation: Implications on a potential return to sport.
      Arthrosc Sports Med Rehabil. 2022; 4: e189-e198
      , 
      • Paster E.
      • Sayeg A.
      • Armistead S.
      • Feldman M.D.
      Rehabilitation using a systematic and holistic approach for the injured athlete returning to sport.
      Arthrosc Sports Med Rehabil. 2022; 4: e215-219
      , 
      • Matsuzaki Y.
      • Chipman D.E.
      • Perea S.H.
      • Green D.W.
      Unique considerations for the pediatric athlete during rehabilitation and return to sport after anterior cruciate ligament reconstruction.
      Arthrosc Sports Med Rehabil. 2022; 4: e221-e230
      , 
      • Gianakos A.L.
      • Abdelmoneim A.
      • Kerkhoffs G.
      • Mulcahey M.K.
      Rehabilitation and return to sport of female athletes.
      Arthrosc Sports Med Rehabil. 2022; 4: e247-e253
      , 
      • Nyland J.
      • Pyle B.
      Self-identity and adolescent return to sports post-ACL injury and rehabilitation: Will anyone listen?.
      Arthrosc Sports Med Rehabil. 2022; 4: e287-e294
      , 
      • Chava N.S.
      • Fortier L.M.
      • Verma N.
      • et al.
      Patients with Medicaid insurance undergoing anterior cruciate ligament reconstruction have lower postoperative international knee documentation committee scores and are less likely to return to sport than privately insured patients.
      Arthrosc Sports Med Rehabil. 2022; 4: e1457-e1464
      , 
      • Betsch M.
      • Darwich A.
      • Chang J.
      • et al.
      Wide variability in return-to-sport criteria used by team physicians after anterior cruciate ligament reconstruction in elite athletes—A qualitative study.
      Arthrosc Sports Med Rehabil. 2022; 4: e1759-e1766
      including many from the ASMAR 2022 special issue on rehabilitation and return to sport
      • Rossi M.J.
      • Brand J.C.
      Rehabilitation is the critical ingredient to optimize return to sport in athletes.
      Arthroscopy. 2022; 38: 7-9
      ; and other journals.
      • Brinlee A.W.
      • Dickenson S.B.
      • Hunter-Giordano A.
      • Snyder-Mackler L.
      ACL reconstruction rehabilitation: Clinical data, biologic healing, and criterion-based milestones to inform a return-to-sport guideline.
      Sports Health. 2022; 14: 770-779
      , 
      • Meredith S.J.
      • Rauer T.
      • Chmielewski T.L.
      • et al.
      Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group.
      Knee Surg Sports Traumatol Arthrosc. 2020; 28: 2403-2414
      , 
      • Rivera-Brown A.M.
      • Frontera W.R.
      • Fontánez R.
      • Micheo W.F.
      Evidence for isokinetic and functional testing in return to sport decisions following ACL surgery.
      PM R. 2022; 14: 678-690
      , 
      • Paterno M.V.
      • Thomas S.
      • VanEtten K.T.
      • Schmitt L.C.
      Confidence, ability to meet return to sport criteria, and second ACL injury risk associations after ACL reconstruction.
      J Orthop Res. 2022; 40: 182-190
      , 
      • Kiran M.
      • Javed O.
      • Roy S.
      • Atwal N.
      • Gosal H.
      Psychological, physical and social factors influence decision to return to sport after revision ACL reconstruction with BPTB graft.
      Knee Surg Sports Traumatol Arthrosc. 2022; 30: 1336-1340
      , 
      • Marom N.
      • Xiang W.
      • Wolfe I.
      • Jivanelli B.
      • Williams III, R.J.
      • Marx R.G.
      High variability and lack of standardization in the evaluation of return to sport after ACL reconstruction: A systematic review.
      Knee Surg Sports Traumatol Arthrosc. 2022; 30: 1369-1379
      , 
      • van Melick N.
      • Pronk Y.
      • Nijhuis-van der Sanden M.
      • Rutten S.
      • van Tienen T.
      • Hoogeboom T.
      Meeting movement quantity or quality return to sport criteria is associated with reduced second ACL injury rate.
      J Orthop Res. 2022; 40: 117-128
      , 
      • Ardern C.L.
      • Glasgow P.
      • Schneiders A.
      • et al.
      2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern.
      Br J Sports Med. 2016; 50: 853-864
      Listeners will also appreciate the informative podcast discussion, “There Is Substantial Variation in Rehabilitation Protocols Following Anterior Cruciate Ligament Reconstruction: A Survey of 46 American Orthopedic Surgeons,” featuring article senior author Anikar Chhabra and podcaster Justin Arner in our Arthroscopy Podcast Library by following the referenced link and clicking 2022: Knee: November 14: Episode #182.
      Arthroscopy Podcast Library.
      https://www.arthroscopyjournal.org/podcast-archive-2022
      Date accessed: December 7, 2022
      Historically, and still today, many surgeons tell patients and families, quite simply, that return to sport will be 6 months after surgery (more or less). Now, we can learn that there is more—much more—to the equation.
      “Prehabiliation”; bracing; time after surgery to various rehabilitation activities; time after surgery until return to sport; functional testing; strength testing, including limb symmetry indices; psychological readiness; age; gender; and type of sport are all factors influencing successful return to sport after ACL injury and treatment. Notably, time after surgery is only one factor among many.
      Age and gender are not modifiable, and for some athletes, type of sport may be nonnegotiable. However, each of these factors could be thoughtfully considered before returning an athlete to sport after ACL treatment. All of the other factors listed above, from prehab to bracing to strength to psychological readiness, may be modifiable. Today, we who treat athletes have the ability to effect immediate, significant improvement in ACL patient outcomes, regardless of surgical technique, by careful determination of when an athlete is ready to return to sport.

      References

        • Rossi M.J.
        • Brand J.C.
        • Lubowitz J.H.
        Minimally clinically important difference (MCID) is a low bar.
        Arthroscopy. 2023; 39: 139-141
        View in Article
        • Glattke K.E.
        • Tummala S.V.
        • Goldberg B.
        • Menzer H.
        • Chhabra A.
        There is substantial variation in rehabilitation protocols following anterior cruciate ligament reconstruction: A survey of 46 american orthopaedic surgeons.
        Arthroscopy. 2023; 39: 578-589
        View in Article
        • Lin T.
        Editorial commentary: There is no standard for or standardization of postoperative rehabilitation protocols after anterior cruciate ligament reconstruction.
        Arthroscopy. 2023; 39: 590-591
        View in Article
        • Turk R.
        • Shah S.
        • Chilton M.
        • et al.
        Critical criteria recommendations: Return to sport after anterior cruciate ligament reconstruction requires evaluation of time after surgery of 8 months, >2 functional tests, psychological readiness, and quadriceps/hamstring strength.
        Arthroscopy. 2023; 39: 790-801
        View in Article
        • Barber-Westin S.D.
        • Noyes F.R.
        Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction.
        Arthroscopy. 2011; 27: 1697-1705
        View in Article
        • Flanigan D.C.
        • Everhart J.S.
        • Pedroza A.
        • Smith T.
        • Kaeding C.C.
        Fear of reinjury (kinesiophobia) and persistent knee symptoms are common factors for lack of return to sport after anterior cruciate ligament reconstruction.
        Arthroscopy. 2013; 29: 1322-1329
        View in Article
        • Fabricant P.D.
        • Chin C.S.
        • Conte S.
        • Coleman S.H.
        • Pearle A.D.
        • Dines J.S.
        Return to play after anterior cruciate ligament reconstruction in major league baseball athletes.
        Arthroscopy. 2015; 31: 896-900
        View in Article
        • Takazawa Y.
        • Ikeda H.
        • Saita Y.
        • et al.
        Return to play of rugby players after anterior cruciate ligament reconstruction using hamstring autograft: Return to sports and graft failure according to age.
        Arthroscopy. 2017; 33: 181-189
        View in Article
        • Tay K.S.
        • Tan A.H.C.
        Clinical outcomes, return to sports, and patient satisfaction after anterior cruciate ligament reconstruction in young and middle-aged patients in an Asian population—A 2-year follow-up study.
        Arthroscopy. 2018; 34: 1054-1059
        View in Article
        • Okoroha K.R.
        • Fidai M.S.
        • Tramer J.S.
        • et al.
        Length of time between anterior cruciate ligament reconstruction and return to sport does not predict need for revision surgery in National Football League players.
        Arthroscopy. 2019; 35: 158-162
        View in Article
        • Glogovac G.
        • Adam P.
        • Schumaier A.P.
        • Brian M.
        • Grawe B.M.
        Return to sport following revision anterior cruciate ligament reconstruction in athletes: A systematic review.
        Arthroscopy. 2019; 35: 2222-2230
        View in Article
        • Wright R.W.
        Editorial commentary: Return to play following revision anterior cruciate ligament reconstruction.
        Arthroscopy. 2019; 35: 2231-2232
        View in Article
        • Nyland J.
        • Taniyama D.
        Editorial commentary: Rehabilitation and return-to-sports readiness, the “black box” of anterior cruciate ligament reconstruction patient recovery.
        Arthroscopy. 2019; 35: 2080-2082
        View in Article
        • Webster K.E.
        • Hewett T.E.
        Is there value and validity for the use of return to sport test batteries after anterior cruciate ligament injury and reconstruction?.
        Arthroscopy. 2020; 36: 1500-1501
        View in Article
        • Springer B.
        • Bechler U.
        • Koller U.
        • Windhager R.
        • Waldstein W.
        Online videos provide poor information quality, reliability, and accuracy regarding rehabilitation and return to sport after anterior cruciate ligament reconstruction.
        Arthroscopy. 2020; 36: 3037-3047
        View in Article
        • Hurley E.T.
        • Manjunath A.K.
        • Strauss E.J.
        • Jazrawi L.M.
        • Alaia M.J.
        Return to play following anterior cruciate ligament reconstruction with extra-articular augmentation: A systematic review.
        Arthroscopy. 2021; 37: 381-387
        View in Article
        • Getgood A.
        Editorial commentary: Return to sport following extra-articular augmentation of anterior cruciate ligament reconstruction—let the LET (lateral extra-articular tenodesis) games commence!.
        Arthroscopy. 2021; 37: 388-390
        View in Article
        • Beletsky A.
        • Naami E.
        • Lu Y.
        • et al.
        The patient acceptable symptomatic state in primary anterior cruciate ligament reconstruction: Predictors of achievement.
        Arthroscopy. 2021; 37: 600-605
        View in Article
        • Leonard J.P.
        Editorial commentary: Preoperative exercise, Workers’ Compensation, diabetes, lateral extra-articular tenodesis, and return to sport determine patient satisfaction after anterior cruciate ligament reconstruction.
        Arthroscopy. 2021; 37: 606-608
        View in Article
        • Jeffers K.W.
        • Shah S.A.
        • Calvert D.D.
        • et al.
        High return to play and low reinjury rates in National Collegiate Athletic Association Division I football players following anterior cruciate ligament reconstruction using quadrupled hamstring autograft.
        Arthroscopy. 2022; 38: 99-106
        View in Article
        • Matzkin E.
        Editorial commentary: Large-diameter quadrupled hamstring autografts are an acceptable option for National Collegiate Athletic Association Division I college football players: We must challenge our comfort zone to be successful in the end zone.
        Arthroscopy. 2022; 38: 107-108
        View in Article
        • Piussi R.
        • Beischer S.
        • Thomeé R.
        • et al.
        Greater psychological readiness to return to sport, as well as greater present and future knee-related self-efficacy, can increase the risk for an anterior cruciate ligament re-rupture: A matched cohort study.
        Arthroscopy. 2022; 38: 1267-1276.e1
        View in Article
        • Webster K.E.
        Editorial commentary: Why the mind matters in anterior cruciate ligament injury recovery: Psychological readiness and return to sport.
        Arthroscopy. 2022; 38: 1277-1278
        View in Article
        • Schaffer J.C.
        • Kuhns B.
        • Reuter J.
        • et al.
        Clinically depressed patients having anterior cruciate ligament reconstruction show improved but inferior rate of achieving minimum clinically important difference for patient-reported outcomes measurement information system compared with situationally depressed or nondepressed patients.
        Arthroscopy. 2022; 38: 2863-2872
        View in Article
        • Nwachukwu B.U.
        Editorial commentary: Clinically depressed patients show worse outcomes after anterior cruciate ligament reconstruction than situationally depressed patients and patients without mood issues.
        Arthroscopy. 2022; 38: 2873-2874
        View in Article
        • Burgess C.J.
        • Stapleton E.
        • Choy K.
        • Iturriaga C.
        • Cohn R.M.
        Decreased performance and return to play following anterior cruciate ligament reconstruction in National Football League wide receivers.
        Arthrosc Sports Med Rehabil. 2021; 3: e455-e461
        View in Article
        • Khalil L.S.
        • Lindsay-Rivera K.G.
        • Abbas M.J.
        • et al.
        Game utilization and performance following RTP from ACL reconstruction does not influence a subsequent second ACL injury in national football league players.
        Arthrosc Sports Med Rehabil. 2021; 3: e1377-e1385
        View in Article
        • Abbas M.J.
        • Khalil L.S.
        • Rahman T.
        • et al.
        Anterior cruciate ligament reconstruction does not impact career earnings after return to play in National Basketball Association athletes.
        Arthrosc Sports Med Rehabil. 2021; 3: e1491-e1497
        View in Article
        • Betsch M.
        • Hoit G.
        • Dwyer T.
        • et al.
        Postoperative pain is associated with psychological and physical readiness to return to sports one-year after anterior cruciate ligament reconstruction.
        Arthrosc Sports Med Rehabil. 2021; 3: e1737-e1743
        View in Article
        • Coquard C.
        • Carrozzo A.
        • Saithna A.
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      DOI: https://doi.org/10.1016/j.arthro.2022.12.003

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      © 2022 by the Arthroscopy Association of North America

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