Anterior Cruciate Ligament Reconstruction in 107 Competitive Wrestlers: Outcomes, Reoperations, and Return to Play at 6-Year Follow-up

Abstract

Background: Wrestling is a physically demanding sport, with young athletes prone to anterior cruciate ligament (ACL) injuries. There is a paucity of data evaluating the results of ACL reconstruction (ACLR) in this cohort. Purpose: To assess return to sport (RTS), patient-reported outcomes, reoperation rates, and graft survival after ACLR in a large cohort of competitive wrestlers at midterm follow-up. Study Design: Case series; Level of evidence, 4. Methods: We identified all competitive wrestlers (club, high school, collegiate, or professional) with a history of an ACLR at a single institution between 2000 and 2019. Graft failure was defined as a retear (as determined via clinical or advanced imaging evaluation) and/or revision ACLR. All patients were contacted for determination of reinjury rates; current sport status; and pain visual analog scale, International Knee Documentation Committee, and Tegner activity scores. Results: Included were 107 knees in 103 wrestlers, with a median follow-up time of 5.9 years (interquartile range [IQR], 3.9-10.3 years). The median age was 17 years (IQR, 15-18 years), with 106 (99%) male patients, and the distribution of bone–patellar tendon–bone (BTB) and hamstring tendon (HT) autografts was 64 (60%) and 43 (40%), respectively. At final follow-up, 80% of athletes were able to RTP at a median of 280 days (IQR, 212-381 days). Graft failure occurred in 14 (13%) knees at a median time of 1.8 years (IQR, 0.7-5.3 years) after the index ACLR. BTB autograft demonstrated a lower failure rate compared with HT autograft (8% vs 21%; P = .044) and was associated with better survival compared with HT autograft up to 15 years after the index ACLR (90.4% vs 76.3%; P = .030). When compared by graft diameter, HT autografts of at least 7.5 mm were not associated with a lower graft failure than BTB constructs of all sizes ( P = .205). Conclusion: Return to competitive wrestling was observed in 80% of athletes after ACLR, with 14% of wrestlers experiencing graft failure. BTB autograft was associated with better survival than HT autograft.

Grappling With Injury

“…Their 2022 study encompassed 64 bone-patellar tendon-bone (BTB) and 43 hamstring autografts in 103 athletes. 10 The authors reported that 80% of the patients were able to return to wrestling a median 280 days after surgery. Graft failure occurred in 14 knees at a median of 1.8 years postoperatively and was significantly more common when a hamstring graft was used.…”

“…Retrospectively reviewing cases treated between 1996 and 2020, Marigi et al 9 were able to report the outcomes in 104 wrestlers: 79 with anterior instability, 14 with posterior instability, and 11 with traumatic multidirectional instability. A total of 58 athletes presented after their initial injury event, while the other 46 experienced multiple episodes of instability before being evaluated.…”

“…17(p186) While only a small portion of wrestling injuries may require surgical treatment, those that do can present a daunting challenge for a successful outcome. In this issue of AJSM, Marigi and colleagues 9 share their institutional experience with the surgical treatment of shoulder instability in competitive wrestlers. Anyone who has witnessed a high school, university, or Olympic style match will probably anticipate that wrestling would test the limits of any repair technique.…”

Outcomes of Shoulder Instability Surgery in Competitive Wrestlers: Outcomes, Reoperations, and Return to Play at 5 Years’ Mean Follow-up

“…19 Compared with other sports, wrestling frequently places athletes at a high risk of sustaining various musculoskeletal injuries. 17,18,21,23 In these young athletes, the downstream sequelae of injuries include recurrent extremity complications, time away from sport, surgery, and psychosocial challenges. 5 Notably, the shoulder girdle is often susceptible to injury as it is a frequent target for the application of supraphysiological forces with or without the presence of generalized ligamentous laxity.…”

Surgical Stabilization for Recurrent Patellar Instability in Competitive Wrestlers: Outcomes, Reoperations, and Return to Play at 6-Year Mean Follow-up

“…The knee is particularly susceptible to injury in wrestlers owing to repetitive supraphysiologic forces applied to an athlete’s hyperflexed knees. 1,5,18,28,29 Lateral patellar dislocation is one such knee injury that commonly occurs in wrestlers. With the exclusion of anatomic risk factors such as trochlear dysplasia and patella alta, a patellar dislocation may be caused by direct contact or lateral stress on a planted foot.…”