The Gap Between Subjective Return to Sports and Subjective Athletic Performance Intensity After Anterior Cruciate Ligament Reconstruction

BACKGROUND: On a questionnaire administered to athletes who had undergone anterior cruciate ligament reconstruction (ACLR), some answered “yes” to a question regarding return to sports (RTS) at the preinjury level despite having lower postoperative subjective athletic performance (PoSAP) intensity compared with preoperative levels. PURPOSE: To investigate the agreement between responses regarding RTS and PoSAP intensity after ACLR. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: A total of 44 individuals, 24.8 ± 18.4 months after ACLR, participated in this study. They completed a questionnaire in which PoSAP was graded as a percentage of preoperative performance level. They also gave dichotomous responses (yes/no) to the question of whether they had been able to RTS at the same level as before their injury (RTS question). Participants were divided into 2 groups according to their PoSAP scores using different cutoff values (100%, 90%, 80%, and 70%), and an exploratory analysis was conducted of the cutoff value for dividing PoSAP scores that provided the greatest agreement with the response to the RTS question. RESULTS: The mean PoSAP score was 87.5% ± 14.9%, and 33 participants (75%) answered “yes” to the RTS question. The agreement between the PoSAP score and the RTS question was lowest when the cutoff value was 100% (κ = 0.294) and highest when the cutoff value was 80% (κ = 0.676) and 90% (κ = 0.632). CONCLUSION: More athletes who had undergone ACLR answered “yes” to the RTS question even when their PoSAP score was around 80%. Asking only for dichotomous responses may result in overestimating the level to which these athletes’ performance has recovered after ACLR.