Contralateral ACL tears strongly contribute to high rates of secondary ACL injuries in professional ski racers

Abstract

Purpose To analyse the efects of graft selection, sex, injury complexity and time to return to competition on the odds to sufer secondary ACL injury (either re-rupture or contralateral ACL tear) in professional alpine skiers. Methods The database of a specialised joint surgery clinic was screened for professional alpine skiers who had participated in competitions at the FIS race, European Cup and World Cup level prior to having to undergo a primary ACL reconstruction, and who had returned to the same competitional level at least one year prior to the end of the observation period. The rates of secondary ACL injuries were statistically compared between athletes with hamstring and quadriceps tendon autografts, men and women, simple and complex (involvement of menisci or cartilage) primary ACL injuries, and between early (≤ 300 days after primary reconstruction) and late (> 300 days) returners to competition. Results Fourteen out of the 30 athletes included (46.7%) sufered secondary ACL injuries on average 29.4 ± 22.5 months after primary reconstruction. The secondary injuries comprised ive re-ruptures (16.7%) and nine contralateral ACL tears (30.0%). The odds to sufer contralateral ACL tears were non-signiicantly higher in patients with hamstring tendon autografts (OR 5.69, n.s.) and in those whose primary injuries were classiied as simple ACL tears (OR 5.31, n.s.). None of the factors assessed was associated with the odds of graft failure. ConclusionThe odds of ACL-injured professional alpine ski racers to sufer secondary ACL tears are nearly 50%, with subsequent contralateral ACL injuries being more common than graft failures. While statistical signiicance could not be established due to a lack of power, greater odds of contralateral ACL tears were observed in athletes with hamstring tendon grafts as well as those with simple primary ACL injuries. No factors potentially predisposing athletes for graft failure could be identiied. Level of evidence III.

Risk of Graft Rupture After Adding a Lateral Extra-articular Procedure at the Time of ACL Reconstruction: A Retrospective Comparative Study of Elite Alpine Skiers From the French National Team

“…The main findings of this study included the observations that elite alpine skiers who underwent ACLR + LEAP had a significantly lower risk of graft rupture as compared with those who underwent an isolated ACLR (HR, 5.286 [95% CI, 1.068-26.149]; P = .0412) and that those who had combined procedures experienced a low rate of ACL graft rupture (6.5%, with a mean exposure time of 2.5 years). This rate can be considered remarkably low given that elite alpine skiing is a notoriously high–risk sport for second ACL injury, as reported in the literature 2,4,23,24,36 and in the current study, with 34.0% of the isolated ACLR group experiencing graft rupture and 37.3% of the overall study population experiencing contralateral ruptures. Although this is the first comparative study of ACLR + LEAP vs isolated ACLR in professional athletes, the results are consistent with those of recent systematic reviews and numerous contemporary comparative studies demonstrating either a downward–trending or significantly reduced graft rupture rate with combined procedures when compared with isolated ACLR in high–risk populations, such as young patients participating in pivoting sports, those with hyperlaxity or chronic ACL injury, and those undergoing revision ACLR.…”

“…Return to international competition was defined by the first date on which skiers participated in competitions at the FIS race, European Cup, or World Cup after ACLR. The interval between surgery and return to international competition was calculated and categorized according to Csapo et al 4 into early returners (<10 months) and late returners (≥10 months).…”

“…18 Current estimates suggest that ACL injuries occur at a rate of 7.6 per 100 skiers per season and that secondary injury rates are high (graft rupture, 16.7%-28%; contralateral injury, 22%-30.5%). 2,4,23,24,36…”

High rate of second ACL injury following ACL reconstruction in male professional footballers: an updated longitudinal analysis from 118 players in the UEFA Elite Club Injury Study

“…A recent study found similar results on professional ski racers with an increased risk of contralateral ACL injury in athletes who had an isolated ACL injury. 39 Importantly, when these two factors (non-contact and isolated ACL injury) were combined, we found that as many as 42% of players sustained a second ACL injury. The increased second ACL injury risk of non-contact and isolated ACL injuries is a novel and clinically very relevant finding which needs to be incorporated in the counselling of the player at the time of the index ACL injury in parallel with appropriate risk stratification management (such as appropriate communication of the second ACL injury risk before and following ACLR based on injury mechanism and pattern).…”

ACL injury prevention: Where have we come from and where are we going?

“…Due to its extremely high ACL injury risk, skiing has had the most ACL IPP research of individual sports. [119][120][121] However, sports such as gymnastics 122 and wrestling 122,123 also carry high risk for ACL injury and require further prevention work due to their unique demands. There is a sparsity of injury surveillance data on smaller "extreme" sports such as skateboarding, BMX, break dancing, or parkour.…”