A Retrospective Descriptive Analysis of Return to Sport Tests and Outcomes Following Anterior Cruciate Ligament Reconstruction Surgery

Abstract

This retrospective descriptive analysis investigated return to sport (RTS) test performance, clinical factors, and sport resumption levels in a cohort of 165 individuals in Aotearoa New Zealand following anterior cruciate ligament reconstruction surgery. Participants were referred for a standardised testing battery involving strength, horizontal hop, vertical jump, and psychological readiness assessments between 2021 and 2025. Findings revealed that while 75% of participants returned to some form of sport, only 43% resumed their pre-injury levels. Horizontal hop tests showed the highest pass rates, whereas strength and vertical jump tests had the lowest, with fewer than half of participants meeting common symmetry thresholds. Psychological readiness demonstrated the strongest association with successful RTS and was significantly lower in those with prior injury or lateral tenodesis procedures. Bone-patellar-tendon-bone grafts were associated with lower knee extension symmetry, while pre-surgery rehabilitation was associated with superior hamstring symmetry. Achieving higher limb symmetry thresholds (≥ 95%) was not associated with higher rates of return to pre-injury levels of sport. These results indicate significant functional deficits at a mean of 52 weeks post-surgery and suggest that RTS decisions should integrate physical, psychological, and contextual factors.