Activity Exposure and Return-to-Sport Outcome Definitions after Adult ACL Revision
Keywords:
return to sport, activity exposure, longitudinal follow-up, graft outcomes, competing events, selectionAbstract
Return to sport after revision anterior cruciate ligament reconstruction is an outcome, a sequence of decisions, and a source of renewed exposure. A final yes-or-no participation label cannot represent all these roles. This conceptual synthesis develops a longitudinal framework around an adult revision-management consensus. It distinguishes participation, return to a prior level, exposure intensity, subsequent injury, and patient goals. The framework explains why a low event rate can coexist with limited activity and why restricting analysis to returners selects a different population from the original cohort. Repeated knee outcomes, explicit time origins, missingness records, and competing-event definitions support the proposed design. No activity records or clinical outcomes are newly analyzed. The contribution is a research specification connecting recovery questions with the exposure process through which later outcomes become observable, without prescribing an individual return date.
Archive transfer
Originally published in Inclusive Growth and Management Quarterly (NB), article 215, on 2026-10-25. Transferred to Studies in Evidence and Discovery on 3 November 2026. The original authors, publication date and article text are retained.
References
- Cao, Mingde, et al. "APKASS 2024 consensus statement on anterior cruciate ligament reconstruction, Part II: Management of anterior cruciate ligament revision in adults." Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 45 (2026): 74-81.
- Grindem, Hege, et al. "Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study." British Journal of Sports Medicine, vol. 50, no. 13, 2016, pp. 804-808. https://doi.org/10.1136/bjsports-2016-096031.
- Fine, Jason P., and Robert J. Gray. "A Proportional Hazards Model for the Subdistribution of a Competing Risk." Journal of the American Statistical Association, vol. 94, no. 446, 1999, pp. 496-509. https://doi.org/10.1080/01621459.1999.10474144.
- Little, Roderick J. A., and Donald B. Rubin. Statistical Analysis with Missing Data. Wiley, 2002. https://doi.org/10.1002/9781119013563.
- Laird, Nan M. and James H. Ware. “Random-Effects Models for Longitudinal Data.” Biometrics, vol. 38, no. 4, 1982, pp. 963. https://doi.org/10.2307/2529876.
- Greenland, Sander, Judea Pearl, and James M. Robins. “Causal Diagrams for Epidemiologic Research.” Epidemiology, vol. 10, no. 1, 1999, pp. 37-48. https://doi.org/10.1097/00001648-199901000-00008.
- Cameron, A. Colin, and Douglas L. Miller. “A Practitioner’s Guide to Cluster-Robust Inference.” Journal of Human Resources, vol. 50, no. 2, 2015, pp. 317–372. https://doi.org/10.3368/jhr.50.2.317.
- von Elm, Erik, et al. "The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies." PLoS Medicine, vol. 4, no. 10, 2007, pp. e296. https://doi.org/10.1371/journal.pmed.0040296.
- Roos, Ewa M., et al. "Knee Injury and Osteoarthritis Outcome Score (KOOS): Development of a Self-Administered Outcome Measure." Journal of Orthopaedic & Sports Physical Therapy, vol. 28, no. 2, 1998, pp. 88-96. https://doi.org/10.2519/jospt.1998.28.2.88.
- Irrgang, James J., et al. "Development and Validation of the International Knee Documentation Committee Subjective Knee Form." The American Journal of Sports Medicine, vol. 29, no. 5, 2001, pp. 600-613. https://doi.org/10.1177/03635465010290051301.
Published
Issue
Section
License
Copyright (c) 2026 Trevor Lawson, Spencer Coleman, Derek Bailey (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.