Sports Participation 25 Years After Anterior Cruciate Ligament Reconstruction: A Prospective Longitudinal Study Comparing Patients With Patellar Tendon and Hamstring Tendon Grafting to Uninjured Controls

BACKGROUND: Approximately 55% of individuals return to previous sports levels after anterior cruciate ligament (ACL) reconstruction (ACLR), but the duration of their sporting life post-ACLR and how this differs from uninjured sports participants is unknown. PURPOSE: To trace the 25-year trajectory of sports participation in individuals who have undergone ACLR and compare sporting activity between graft types and between ACLR individuals and uninjured controls. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 62 individuals (44 males; mean age, 27 years) underwent ACLR (31 bone-patellar tendon-bone grafting, 31 semitendinosus/gracilis grafting). Sporting activity was assessed preinjury, at 6 and 25 years after surgery on a 6-point scale based on pivoting demands. A total of 30 uninjured individuals matched for age, sex, and sporting activity were assessed at equivalent time points. Pearson chi-square and Student t tests were used to compare outcomes between graft types and between ACLR individuals and controls. RESULTS: In total, 50 (81%) individuals (35 males) with ACLR and 20 (67%) uninjured controls were followed up after 25 years. Overall, 88% of the ACLR group were active in sports, 22% in vigorous pivoting sports. Three ACLR individuals had total knee replacements, 9 ruptured their contralateral ACL, and 8 ruptured their graft. There was no significant difference between graft types in sports level played presurgery (P = .442), 6 years after surgery (P = .511), or 25 years after surgery (P = .100). At 25 years after surgery, ACLR individuals participated in sports at higher levels (P = .005) and over longer periods (P = .032) than controls. CONCLUSION: Interestingly, after ACLR, patients were more engaged in sports than uninjured controls. Although the level of sports activity typically decreased over 25 years, findings highlight the potential for longevity in sports after an ACLR, irrespective of graft type.