Most people have not returned to their pre-injury level of sports participation 12 months following anterior cruciate ligament (ACL) reconstruction surgery. Twelve months may be too early to assess return to sport outcomes accurately. The purpose of this study was to evaluate the mid-term return to sport outcomes following ACL reconstruction surgery.

A self-report questionnaire was used to collect data from people at 2 to 7 years following ACL reconstruction surgery regarding pre-injury sports participation, post-operative sports participation and subjective knee function. The main inclusion criteria were participation in regular sports activity prior to surgery and the attendance of routine surgical follow up appointments.

A total of 314 people were included at a mean 39.6 ± 13.8 months following ACL reconstruction surgery. At follow up, 45% of people were playing sport at their pre-injury level and 29% were playing competitive sport. Of those playing competitive sport prior to injury, 46% were playing competitive sport at follow up. Ninety three percent of people had attempted sport at some time following their ACL reconstruction surgery. People who had not attempted their pre-injury level of sport by 12 months following surgery were just as likely to have returned to pre-injury level by 39 months after surgery as those who had played sport by 12 months (risk ratio, 95% CI = 1.1, 0.76–1.6).

Less than 50% of people had returned to either their pre-injury level of sport or competitive sport when surveyed at 2 to 7 years following ACL reconstruction surgery. Sporting activity at 12 months was not predictive of participation at 2 to 7 years, suggesting that people who return to sport within 12 months may not maintain their sports participation.