Abstract
Objectives:
Prior studies report lower return to preinjury level of sport in patients who undergo bilateral anterior cruciate ligament (ACL) reconstructions compared to unilateral reconstructions, with the most common cited reason being fear of reinjury. The purpose of our investigation was to compare subsequent return rates and psychological readiness to return to sport (RTS) in patients who underwent bilateral versus unilateral ACL reconstructions.
Methods:
A retrospective review of patients who underwent ACL reconstruction at a single academic institution between 2012-2021 with a minimum of 1-year follow-up was conducted. Patients were divided into bilateral and unilateral cohorts. Those who underwent bilateral ACL reconstruction were matched 1:3 to unilateral reconstruction based on age, sex, BMI, and primary sport. Primary outcomes included return to sport, level of RTS and psychological readiness to RTS, assessed by the validated ACL- Return to Sport after Injury (ACL-RSI) scale. Within the ACL-RSI questionnaire, fear and confidence to return to sport were specifically analyzed. Fear to RTS was measured on a scale of 0-100 with 0 equal to extremely fearful and 100 equal to no fear at all. Confidence to RTS was measured on a scale of 0-100 with 0 equal to not at all confidence and 100 equal to fully confident. Statistical analysis was performed in R studio, with chi-square used for categorical values and two-sided t-test for continuous.
Results:
One hundred eighty-one patients were included, forty-three bilateral ACL reconstructions and one hundred thirty-eight unilateral. The unilateral cohort included 69 (50.0%) males and 69 (50.0%) females and the bilateral cohort included 22 (51.2%) males and 21 (48.8%) females. Mean age was 26.0 (14-56) in the unilateral cohort and 25.2 (14-50) in the bilateral cohort. Mean BMI was 25 (15.3-39.2) in the unilateral cohort and 28 (15.1-39.7[SM1] ) in the bilateral cohorts (p=.08). The percentage of individuals who returned to sport in the bilateral reconstruction cohort was not significantly different from those who returned in the unilateral cohort (79.6% vs 76.7%, p=0.85). There was no significant difference in psychological readiness to RTS (mean score 52.6 for bilateral and 47.4 for unilateral, p=0.31). There was also no significant difference between the level at which bilateral versus unilateral patients returned to sport. 59.6% unilateral returned to the same or higher level and 60.6% bilateral returned to the same or higher level, p=0.92. There was no significant difference in the reported scale of psychological readiness to return to sport (52.6 for bilateral and 47.4 for unilateral, p=0.31). When asked about fear to RTS, the mean scale response was 42.2 in the unilateral cohort and 46.5 in the bilateral (p=0.45).
Conclusions:
There is no difference in RTS and level of sport returned to between patients who undergo bilateral ACL reconstructions compared to patients who undergo unilateral ACL reconstructions. Psychological readiness, fear and confidence to return to sport were not different between unilateral and bilateral injuries.