Return-to-Sport Outcomes and Psychological Readiness to Return to Sport After Revision Compared to the Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis.

Abstract

Background: The existing body of evidence referring to the return-to-sport (RTS) outcomes and psychological readiness to return to sport after revision compared to the primary anterior cruciate ligament (ACL) reconstruction has not yet been comprehensively synthesized.

Objective: To examine RTS outcomes and psychological readiness to return to sport after revision compared to the primary ACL reconstruction.

Methods: A comprehensive search of Web of Science, EMBASE, and PubMed was carried out up to November 15, 2024. Observational studies that compared revision and primary ACL reconstruction regarding RTS outcomes and psychological readiness to return to sport were considered adequate for inclusion. The Methodological Index for Non-Randomized Studies and Grading of Recommendations Assessment, Development, and Evaluation were used to assess methodological quality as well as the overall strength and quality of evidence of involved studies, respectively.

Results: A total of 19 studies fulfilled the eligibility criteria and were included in the quantitative analysis. There were 3209 athletes with a history of revision and primary ACL reconstruction (mean age: 26.0 ± 6.5 years; 78% males). The main findings indicated that individuals who were subjected to revision ACL reconstruction had slightly lower odds of RTS (-6%; odds ratio (OR) = 0.66 [95% confidence interval (CI) 0.49 to 0.89]), slightly lower odds of RTS at the preinjury level of competition (-5%; OR = 0.52 [95% CI 0.36 to 0.76]), slightly prolonged RTS time (1.2 months; standardized mean differences (SMD) = 0.38 [95% CI 0.12 to -0.63]), and moderately lower psychological readiness to return to sport (-14.2 points; SMD = -0.75 [95% CI -1.14 to -0.36]) relative to their counterparts who were subjected to the primary ACL surgery.

Conclusions: Athletes who underwent the revision ACL surgery had a 6% reduced rate of RTS, 5% lower rates of RTS at the preinjury level of competition, 1.2 months extended RTS time, and 14.2 points decreased psychological readiness to return to sport relative to the respondents with a history of the primary ACL reconstruction. PROSPERO registration number CRD42024600347.