Compliance in post-operative rehabilitation is a key factor for return to sport after revision anterior cruciate ligament reconstruction

Francesco Della Villa, Luca Andriolo, Margherita Ricci, Giuseppe Filardo, Jacopo Gamberini, Daniele Caminati, Stefano Della Villa, Stefano Zaffagnini

Research output: Contribution to journalArticlepeer-review


PURPOSE: To assess the rate of return to sport (RTS) following revision Anterior Cruciate Ligament Reconstruction (ACLR) in a rehabilitation-based cohort of patients. A secondary goal of the study was to evaluate the association between compliance in post-operative rehabilitation and RTS rate.

METHODS: The study cohort included 79 sport-active patients (62 males, 17 females, 30.0 ± 10.2 years old) who underwent revision ACLR surgery and followed the same functional-oriented rehabilitation protocol. Patients were evaluated using a RTS survey: return to any kind of sport participation, return to the same pre-injury sport, return to the same sport at the same pre-injury level. With regards to compliance in post-operative rehabilitation, patients were then grouped in (1) Fully Compliant (FC), (2) Moderately Compliant (MC), (3) Scarcely Compliant (SC), and (4) Non-Compliant (NC).

RESULTS: At an average follow-up of 29 ± 12 months, 86% of the patients returned to some kind of sport activity, 62% returned to the same pre-injury sport activity and 59% returned to the same pre-injury level of sport activity. While no surgical aspects were correlated with RTS, higher BMI was found to have a negative influence (p = 0.033). Regardless of the type of sport, compliance significantly affected RTS at the same pre-injury level (p = 0.006): 86% in FC, 67% in MC, 50% in SC, and 45% in NC. For each compliance goal achieved, the probability of RTS increased by 68% (OR = 1.68; p = 0.027).

CONCLUSION: RTS at the same pre-injury level after revision ACLR is challenging. A higher compliance in rehabilitation significantly increases the chances of RTS.


Original languageEnglish
Pages (from-to)463-469
Number of pages7
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Issue number2
Publication statusE-pub ahead of print - Aug 3 2019


  • ACL rehabilitation
  • Compliance
  • Return to play
  • Return to sport
  • Revision ACL reconstruction


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