This study analyzed factors influencing scores on the K-STARTS return to sport test battery in 676 patients who underwent ACL reconstruction. The only factor found to significantly influence scores above the minimal detectable change threshold was completion of a specific return to sport program in addition to standard rehabilitation, which resulted in improved K-STARTS scores at 6 months post-surgery compared to standard rehabilitation alone. No other factors such as age, sex, graft type, or meniscal injury status significantly influenced scores.

1. Factors Influencing the Outcomes of a Validated Return to Sports Test Battery
after ACL Reconstruction: A Retrospective Analysis of 676 Patients
Adnan Saithna, MD, FRCS(T&O)1,2
Professor of Orthopedic Surgery, Adjunct Clinical Faculty, Kansas City University
Florent Franck3, Jean Marie Fayard3, Isabelle Rogowski3, Gregory Vigne3, Thais Dutra Vieira3 ,Charles Pioger3
Mathieu Thaunat3 and Bertrand Sonnery-Cottet3
1. Kansas City University of Medicine and Biosciences, Missouri, USA
2. Sano Orthopedics, Overland Park, KS, USA
3. Santy Clinic, FIFA Center for Medical Excellence, Lyon, France
Abstract: P0407

2. FINANCIAL DISCLOSURE
LIST ALL DISCLOSURES FROM PAST 12 MONTHS
Presenter: Adnan Saithna, MD
No Disclosures in the last 12 months
Co-author:
Bertrand Sonnery-Cottet, MD
Consultant for Arthrex, Royalties from Arthrex
Mathieu Thaunat, MD
Consultant for Arthrex

3. BACKGROUND/OBJECTIVE
• Second ACL injuries (defined as a graft rupture or contralateral ACL rupture) are
common after ACL reconstruction.
• It is postulated that this observation could reflect a premature attempt to return to
sports (RTS) and that delaying RTS until certain quality indicators or rehabilitation
milestones are met could reduce the risk.
• There is consequently considerable interest in the application of RTS criteria. Multiple
authors have reported that patients who passed a battery of tests prior to RTS, had a
lower risk of re-injury and an increased rate of return to sport. However, factors
influencing RTS scores have not been well studied.
• The aim of this study was to determine the key factors that influence RTS test scores.

4. METHODS AND MATERIALS
• Retrospective analysis of consecutive patients who underwent primary ACL
reconstruction between March 2016 and May 2017, who also had a documented RTS
evaluation with K-STARTS, (a validated, composite psychological and functional RTS
test battery [1] at 6 months following surgery, was undertaken. All patients underwent
the same standardized rehabilitation program but in addition to this they were offered
the opportunity to participate in a separate individualized RTS program. If patients
chose to participate in the RTS program, this would occur in addition to the standard
program and not instead of it.
• Demographic data and characteristics including the frequency of pre-injury sports
participation, Tegner score, time from injury to surgery, graft type, the presence of
meniscal lesions, whether a lateral tenodesis was performed, and whether patients
participated in the specific RTS program in addition to physiotherapy were recorded.
• To identify factors influencing the K-STARTS score at six months postoperatively, an
analysis of variances was performed. When a significant effect was found, post hoc
comparisons were made using Tukey’s HSD tests with Bonferroni’s correction

5. SCORING THE K-STARTS TEST BATTERY

6. REHABILITATION PROTOCOLS

7. RESULTS
676 patients were included in the study. The mean K-STARTS score of the overall population
was 13.5 (95% CI 13.2 to 13.8). Population characteristics are reported below

8. FACTORS INFLUENCING THE K-STARTS SCORE

9. DISCUSSION
• The main finding of this study was that the only factor that influenced the K-STARTS
score beyond the minimal detectable change threshold (3.3 points) was completion
of a specific return to sports program resulted in a significant improvement in return
to sports test scores. Although this is a new finding, it is consistent with Edwards et
al [2] who reported that completed rehabilitation was the most important factor
influencing successful return to sport, and that patients who completed rehabilitation
were almost eight-times more likely to return to sport compared with those who did
not.
• Furthermore, Edwards et al also reported that failure to complete rehabilitation was
associated with much higher rates of failing return to sports testing criteria.

10. CONCLUSION
• Completion of a specific return to sports program, in addition to standard
rehabilitation, is associated with a significantly improved K-STARTS composite
functional and psychological return to sports test score at 6 months after ACL
reconstruction.

11. REFERENCES
1. Blakeney WG, Ouanezar H, Rogowski I, Vigne G, Guen ML, Fayard JM, Thaunat
M, Chambat P, Sonnery-Cottet B. Validation of a Composite Test for Assessment of
Readiness for Return to Sports After Anterior Cruciate Ligament Reconstruction:
The K-STARTS Test. Sports Health. 2018 Nov/Dec;10(6):515-522. doi:
10.1177/1941738118786454. Epub 2018 Jul 19.
1. Edwards, P. K., Ebert, J. R., Joss, B., Ackland, T., Annear, P., Buelow, J.-U., &
Hewitt, B. (2018). Patient Characteristics and Predictors of Return to Sport at 12
Months After Anterior Cruciate Ligament Reconstruction: The Importance of Patient
Age and Postoperative Rehabilitation. Orthopaedic Journal of Sports Medicine, 6(9),
232596711879757.doi:10.1177/2325967118797575