Female Soccer Players With Anterior Cruciate Ligament Reconstruction Have a Higher Risk of New Knee Injuries and Quit Soccer to a Higher Degree Than Knee-Healthy Controls

Fältström, Anne; Kvist, Joanna; Gauffin, Håkan; Hägglund, Martin

doi:10.1177/0363546518808006

Cited by 54 publications

(55 citation statements)

References 38 publications

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“…Some patients had revision ACL reconstruction with various grafts (including bone–patellar tendon–bone, iliotibial band, or synthetic ligament) that may affect the risk of OA in different ways. 28 Returning to sports after ACL injury increases the risk for new knee injuries 16 and, subsequently, the risk for OA. 8 , 31 We have data on sports participation at short-term follow-up (4 years after index injury), but we do not have data on sports participation between 5 and 30 years after the index injury.…”

Section: Discussionmentioning

confidence: 99%

Radiographic and Symptomatic Knee Osteoarthritis 32 to 37 Years After Acute Anterior Cruciate Ligament Rupture

et al. 2020

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Background: The long-term prevalence of knee osteoarthritis (OA) after anterior cruciate ligament (ACL) injury is unknown, especially in patients without a history of ACL surgery. Purpose: To (1) describe the prevalence of radiographic OA, symptomatic OA, and knee replacement surgery 32 to 37 years after acute ACL injury and to (2) compare the prevalence of radiographic OA, symptomatic OA, and knee symptoms between patients allocated to early ACL surgery or no ACL surgery and patients who crossed over to ACL surgery. Study Design: Cohort study; Level of evidence, 2. Methods: Participants aged 15 to 40 years at the time of ACL injury were allocated to surgical (augmented or nonaugmented ACL repair) or nonsurgical ACL treatment within 14 days of injury. At 32 to 37 years after the initial injury, 153 participants were followed up with plain weightbearing radiographs and completed 4 subscales from the Knee injury and Osteoarthritis Outcome Score (KOOS). Radiographic OA was defined as Kellgren and Lawrence grade 2 or higher. Symptomatic OA was defined as radiographic OA plus knee symptoms measured with the KOOS. Results: Participants allocated to ACL surgery (n = 64) underwent surgery at a mean ± SD of 5 ± 4 days (range, 0-11 days) after injury. Of the 89 participants allocated to no ACL surgery, 53 remained nonsurgically treated, 27 had ACL surgery within 2 years, and 9 had ACL surgery between 3 and 21 years after injury. In the total sample, 95 participants (62%) had radiographic tibiofemoral OA, including 11 (7%) who had knee replacement. The prevalence of radiographic tibiofemoral OA was lower in the group allocated to ACL surgery compared with the group who never had ACL surgery (50% vs 75%; P = .005). The prevalence of symptomatic OA (50% in the total sample) and patellofemoral radiographic OA (35% in the total sample) was similar between groups. Conclusion: Patients allocated to early ACL surgery, performed a mean 5 days after injury, had a lower prevalence of tibiofemoral radiographic OA at 32 to 37 years after injury compared with patients who never had ACL surgery. The prevalences of symptomatic OA, radiographic patellofemoral OA, and knee symptoms were similar irrespective of ACL treatment. Overall, the prevalence of OA after ACL injury was high. Registration: NCT03182647 (ClinicalTrials.gov identifier)

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Section: Discussionmentioning

confidence: 99%

Radiographic and Symptomatic Knee Osteoarthritis 32 to 37 Years After Acute Anterior Cruciate Ligament Rupture

et al. 2020

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“…15,18,19 Additionally, they have a 3.8times higher retear rate than do men after undergoing reconstruction and almost a 5-fold higher rate of subsequent ACL injury as compared with female soccer player controls with no previous knee injury. 7,8,11 There is also a 28% rate of ACL retear after ACLR and a 34% rate of retear after returning to soccer. 2 Aside from associated risks with sex and sport participation, our population is at higher risk for reinjury given its young age and the known association with higher reinjury.…”

Section: Discussionmentioning

confidence: 99%

“…Functional performance testing has not been shown to differ between ACLR and control groups. 8 In addition to the unexplained higher tear rates, Tegner activity scores among female soccer players have been shown to decrease at a higher rate in those with ACLR as compared with controls. 6,7 Despite extensive literature on ACLR and soccer players, the optimal graft option for female soccer players is still unclear.…”

Section: Discussionmentioning

confidence: 99%

The Challenges of Treating Female Soccer Players With ACL Injuries: Hamstring Versus Bone–Patellar Tendon–Bone Autograft

Britt

Ouillette

Edmonds

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Although anterior cruciate ligament (ACL) injuries are common in female soccer players, the optimal graft option for ACL reconstruction is currently unclear. Purpose/Hypothesis: To compare the outcomes of female soccer players after ACL reconstruction using either hamstring tendon autograft or bone–patellar tendon–bone (BTB) autograft. We hypothesized that there would be no difference in clinical outcome scores, return to sport, or retear rates between BTB and hamstring grafts in our study cohort. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective review of all skeletally mature adolescent female soccer players who underwent primary ACL reconstruction using either hamstring tendon or BTB autograft between 2013 and 2016. Demographic, injury, and surgical variables were documented. Outcome measures included the Lysholm score, Single Assessment Numeric Evaluation, Tegner activity score, and visual analog scales for pain and for satisfaction, as well as ability to return to sport. Results: Overall, 90 female soccer players met the inclusion criteria, of whom 79% (41 BTB and 30 hamstring) were available for a minimum 2-year follow-up or had a graft failure before the follow-up. The BTB group had a lower body mass index (mean ± SD, 23 ± 3 vs 25 ± 4; P = .02) and shorter postoperative follow-up time in months (mean ± SD, 37.4 vs 46.1; P ≤ .001); otherwise, no differences in demographic, injury, or surgical variables between groups were noted. Regarding outcome measures, the BTB group achieved a higher Tegner score (6.0 vs 4.2; P = .004), and there was no other difference between groups. Of the patients who did not return to soccer, 44.7% reported fear as the reason. Of the patients who did return to soccer, 31.9% sustained another ACL injury (retear or contralateral tear), with no differences in reinjury rates based on graft selection. Conclusion: Adolescent female soccer players undergoing ACL reconstruction had relatively high satisfaction and outcome scores independent of autograft choice. Notwithstanding, patients and families need to be counseled that less than half of patients will return to their preinjury level of sport and, if an athlete attempts to return, there is a high risk of further ACL injury.

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“…54,55,58 This information is important in the field of sports medicine because injuries impose a large expense and have the potential to alter lifelong health and activity. 17,35,59 Although not all injuries can be avoided through preventive action, the reduction of many injuries with the application of preemptive interventions, such as targeted neuromuscular training, is possible and has shown promise. 22,40,58 Of course, this will only be possible with technology that brings observation of these values to the point of care with simple, accessible tools and validated algorithms.…”

Section: Discussionmentioning

confidence: 99%

Linear Discriminant Analysis Successfully Predicts Knee Injury Outcome From Biomechanical Variables

et al. 2020

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Background: The most commonly damaged structures of the knee are the anterior cruciate ligament (ACL), medial collateral ligament (MCL), and menisci. Given that these injuries present as either isolated or concomitant, it follows that these events are driven by specific mechanics versus coincidence. This study was designed to investigate the multiplanar mechanisms and determine the important biomechanical and demographic factors that contribute to classification of the injury outcome. Hypothesis: Linear discriminant analysis (LDA) would accurately classify each injury type generated by the mechanical impact simulator based on biomechanical input variables (ie, ligament strain and knee kinetics). Study Design: Controlled laboratory study. Methods: In vivo kinetics and kinematics of 42 healthy, athletic participants were measured to determine stratification of injury risk (ie, low, medium, and high) in 3 degrees of knee forces/moments (knee abduction moment, anterior tibial shear, and internal tibial rotation). These stratified kinetic values were input into a cadaveric impact simulator to assess ligamentous strain and knee kinetics during a simulated landing task. Uniaxial and multiaxial load cells and implanted strain sensors were used to collect mechanical data for analysis. LDA was used to determine the ability to classify injury outcome by demographic and biomechanical input variables. Results: From LDA, a 5-factor model (Entropy R2 = 0.26) demonstrated an area under the receiver operating characteristic curve (AUC) for all 5 injury outcomes (ACL, MCL, ACL+MCL, ACL+MCL+meniscus, ACL+meniscus) of 0.74 or higher, with “good” prediction for 4 of 5 injury classifications. A 10-factor model (Entropy R2 = 0.66) improved the AUC to 0.86 or higher, with “excellent” prediction for 5 injury classifications. The 15-factor model (Entropy R2 = 0.85), produced 94.1% accuracy with the AUC 0.98 or higher for all 5 injury classifications. Conclusion: Use of LDA accurately predicted the outcome of knee injury from kinetic data from cadaveric simulations with the use of a mechanical impact simulator at 25° of knee flexion. Thus, with clinically relevant kinetics, it is possible to determine clinical risk of injury and also the likely presentation of singular or concomitant knee injury. Clinical Relevance: LDA demonstrates that injury outcomes are largely characterized by specific mechanics that can distinguish ACL, MCL, and medial meniscal injury. Furthermore, as the mechanics of injury are better understood, improved interventional prehabilitation can be designed to reduce these injuries.

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Female Soccer Players With Anterior Cruciate Ligament Reconstruction Have a Higher Risk of New Knee Injuries and Quit Soccer to a Higher Degree Than Knee-Healthy Controls

Cited by 54 publications

References 38 publications

Radiographic and Symptomatic Knee Osteoarthritis 32 to 37 Years After Acute Anterior Cruciate Ligament Rupture

Radiographic and Symptomatic Knee Osteoarthritis 32 to 37 Years After Acute Anterior Cruciate Ligament Rupture

The Challenges of Treating Female Soccer Players With ACL Injuries: Hamstring Versus Bone–Patellar Tendon–Bone Autograft

Linear Discriminant Analysis Successfully Predicts Knee Injury Outcome From Biomechanical Variables

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