Q: I am an assistant coach of a women's basketball team at a small college. In the past, I've worked with both male and female athletes. I've noticed something I wonder about. When an athlete injures his or her ACL and has surgery, they don't all get back on the court in the same time frame. Some don't ever make it back. Is this a matter of personality, competitive edge, type of surgery, or something else?

A: You have asked a good question that has been addressed by some experts looking for answer to these questions: what keeps athletes who have had ACL surgery from getting back into the game sooner than later? Why do some athletes stop playing and competing altogether after ACL reconstructive surgery?

Short-term (12 month) studies show that most people have not returned to their preinjury level of sports play following reconstructive surgery for a torn ACL. The authors of a recent study extended the timeline to look at medium-term results to see what happens to these athletes months to years later.

They surveyed 314 athletes of all ages two to seven years after their ACL surgery. Athletes who filled out the self-report questionnaire answered questions about their level of sports participation before the injury and after the surgery. They also commented on overall knee function.

Almost everyone (93 per cent) tried to participate in their sport after their surgery. Only about half of them were successful. And only one-third were playing competitively. Athletes who returned to sports at their preinjury level by the end of the first year didn't always stay in their sport competitively. That told the researchers that short-term results (12 months after surgery) aren't always an accurate reflection of what will happen months to years later.

Variables that differed from patient to patient included age, lifestyle factors, and exposure to sports opportunities. Analysis of the data collected included these factors because the researchers thought perhaps younger patients were more likely to be involved in school sports. They would therefore have more opportunities for sports participation. Older patients might be prevented from getting back into play because of family or work. And as it turned out, more patients 25 years old and older were, in fact, not playing anymore compared with the younger (less than 25 years of age) athletes.

This study provided evidence that failure to regain preinjury sports ability is directly linked with the function of the operative leg. Other personal factors also played an important role in the decision to return-to-sport. More study is needed to tease out the differences among groups of same-age/same sex athletes compared with same age/different sex players.

Reference: Clare L. Ardern, BPhysio(Hons), et al. Return-to-Sport Outcomes 2 to 7 years After Anterior Cruciate Ligament Reconstruction Surgery. In The American Journal of Sports Medicine. January 2012. Vol. 40. No. 1. Pp. 41-48.