Anterior Cruciate Ligament (ACL) tear is a common orthopaedic injury in sportspersons. ACL reconstruction (ACLR) is the treatment of choice for the same. The goal of ACL reconstruction surgery is to restore the normal function of the knee and allow a subsequent return to sports as early as possible. However, despite improvement of surgical techniques and better method of fixation of graft, return to sports (RTS) is still not guaranteed in all the patients. Various studies have shown that return to sports after ACLR has been possible in 55-80% of cases. 

The most commonly used autografts in ACLR are Bone Patellar tendon Bone (BPTB) autograft and Semitendinosus-Gracilis (hamstring) free autograft (STGF). BPTB graft has been reported to have the advantage of good mechanical stability and low rupture rate but disadvantages of donor site morbidity and anterior knee pain. STGF autograft has advantages of not having donor site morbidity and having a good functional outcome but has the disadvantage of high rupture rate. Semitendinosus-Gracillis graft with preserved tibial insertion (STGPI) is another option in the clinical setting with low graft failure rate like that of BPTB graft and with the added advantage of not having significant donor site morbidity. In STGPI, because we are not severing the insertions of the hamstring tendons from the tibia, the blood supply of the tendons remains preserved. Hence preserving the insertions in this technique preserves the biology to a greater extent than the severed insertions in the case of STGF and potentially promotes superior healing of the graft; this may minimize the risk of graft elongation, and preserve the mechanoreceptors in the graft tissue and has been reported to have better results in terms of proprioception.6,8 However, there is no statistically significant difference amongst the three grafts in terms of return to sports and mechanical stability. Since STGPI has comparable outcomes in terms of RTS with BPTB, and factors affecting RTS have not been studied extensively in ACLR with STGPI, we aim to find out the co-relation of these factors with RTS using STGPI.

So far there is no consensus on as to what should be the ideal time for RTS after ACLR, which is the most frequent and important question from the sportsperson’s point of view. A number of factors have been suggested by several authors on which the outcome of ACLR depends. There are studies co-relating certain parameters like thigh wasting, type of sports and duration of injury with RTS after ACLR, but most of them do not concern the more important factor, that is the return to competition (RTC) after ACLR, which means returning

to the same level of competitive sports as the pre-injury state, especially in the context of sportspersons. There are very few studies showing a relation of younger age group of presentation with an increased rate of graft failure after ACLR, but there is no study showing a direct relation between age at the time of injury and RTS. Similarly there is not enough literature on the co-relation between socio-economic status of a patient, and the outcome of ACLR, and through our study we also aim to find out if socio-economic status also has an impact on RTS after ACLR. We hypothesize that lower is the socio-economic score of the sportsperson, higher is the tendency to avoid re-injury due to economic reasons.

Graft size has also been co-related with graft failure post ACLR, but none of the studies show a direct co-relation between graft size and RTS.14 We also aim to study fear of re-injury as a factor for preventing RTS. There have been a few studies stressing on the importance of fear of re-injury having a negative impact on the outcome of ACLR in terms of RTS, but none of the studies have been undertaken on ACLR using STGPI which has a better result in terms of proprioception.

Our study becomes unique due to the fact that, although these factors have been studied in relation to ACLR in many studies individually, there is very scant literature showing the relation of a combination of these factors in a single study. Also majority of the literature in the past has been studied on either BPTB or STG free grafts, and since we hypothesize that STGPI has a similar outcome to BPTB, this study will help us determine the outcome of STGPI in terms of RTS as a technique for ACLR.

The purpose of this study is to find out the co-relation of parameters such as age, thigh wasting, duration of injury before surgery, graft size, socio-economic status, type of sports, and fear of re-injury with both RTS and returning to the same level of sports.