Return to Military Duty After Anterior Cruciate Ligament Reconstruction

Background: Return to play and risk factors for functional limitations have been widely reported among athletes following anterior cruciate ligament reconstruction (ACLR) but has not been well studied in the military population. Methods: We conducted a retrospective review of all active duty service members who underwent primary ACLR at our institution between 2005 and 2010. The primary endpoints evaluated included Medical Evaluation Board (MEB) and activity limitations as noted by permanent profile (PP) following surgery. Demographic and surgical information was collected including age, gender, Military Occupational Specialty, tobacco use, rank, associated meniscal/chondral injuries, graft type, graft size, graft failure, and subsequent surgeries. All patients were greater than 2 yr postoperatively from index ACLR. Findings: A total of 470 patients met inclusion criteria for the study. There were 428 men and 42 women with a mean age of 28.5 yr. Of the 470 patients, 247 (52.6%) required either MEB, PP, or both following surgery; 129 (27.4%) required a PP only; 53 (11.3%) required a MEB only; and 65 (13.8%) required both PP and MEB following surgery. Only 223 patients (47.4%) returned to full duty without restrictions following ACLR. Both anterior cruciate ligament graft failure and subsequent surgeries were found to be statistically significant predictors for PP and/or MEB (p < 0.0001). Age, tobacco use, rank, associated meniscal/chondral injury, graft type, and graft size were not found to be significant predictors for subsequent PP and/or MEB. Female gender trended toward significance as a risk factor with 27 of 41 females (65.9%) requiring PP and/or MEB (p = 0.07). Service members in a noncombat arms role were more likely to require PP and/or MEB than those in a combat arms role (p = 0.03). Discussion: Return to full duty following ACLR in active duty soldiers is lower than may be expected. More than 50% of service members have activity limitations or are unable to return to duty following surgery. These findings allow for preoperative discussion of expected outcome and the possibility that an anterior cruciate ligament tear even when reconstructed can lead to permanent military activity limitations and MEB.