High Risk of New Knee Injuries in Female Soccer Players After Primary Anterior Cruciate Ligament Reconstruction at 5- to 10-Year Follow-up

Abstract

Background: A new anterior cruciate ligament (ACL) injury after ACL reconstruction is a feared outcome. Purpose: To study the risk of new knee injuries in female soccer players 5 to 10 years after primary unilateral ACL reconstruction and to compare players who returned to soccer with (1) players who did not return and (2) knee-healthy soccer players (controls). Study Design: Cohort study; Level of evidence, 2. Methods: Demographic, soccer-specific, and surgical data were recorded at baseline for 317 female soccer players (mean ± SD age, 20.1 ± 2.7 years) 1.6 ± 0.7 years after ACL reconstruction and for 119 matched controls (mean age, 19.5 ± 2.5 years). Data on new knee injuries and soccer-playing status were collected 5 to 10 years after ACL reconstruction via a questionnaire. Results: Among players with ACL reconstruction, 222 (70%) responded at a mean 6.5 ± 1.0 years after primary ACL reconstruction. We compared 3 cohorts: (1) among 163 players with ACL reconstruction who returned to soccer, 68 (42%) sustained 44 reruptures and 29 contralateral ruptures; (2) among 59 players with ACL reconstruction who did not return to soccer, 11 (19%) sustained 9 reruptures and 2 contralateral ruptures; and (3) among 113 knee-healthy controls, 12 (11%) sustained 13 ACL injuries. Players who returned had a >2-fold higher risk of a new ACL injury than players who did not return (risk ratio, 2.24; 95% CI, 1.27-3.93; P = .005) and a 4-fold higher risk than controls (risk ratio, 3.93; 95% CI, 2.23-6.91; P <.001). A new ACL, meniscal, or cartilage injury was the most frequent new knee injury. Among players who returned to soccer, 68% reported a new knee injury, and they had a 2- to 5-times higher risk of any new knee injury and knee surgery than players who did not return and controls. Conclusion: Two-thirds of female soccer players with ACL reconstruction who returned to soccer sustained a new knee injury within 5 to 10 years; 42% had a new ACL injury. Their risk of a new knee injury and knee surgery was 2 to 5 times greater than that for players who did not return and for knee-healthy controls. New injury may have negative consequences for long-term knee health and should be a critical consideration in the decision to return to play.

Comparable Instrumented Knee Joint Laxity and Patient-Reported Outcomes After ACL Repair With Dynamic Intraligamentary Stabilization or ACL Reconstruction: 5-Year Results of a Randomized Controlled Trial

“…However, rerupture rates up to 27% were found after ACL reconstruction in younger athletes and with longer follow-up periods. 4 , 11 , 12 , 26 , 44 In the present study, the rate of recurrent instability at 5 years after ACL reconstruction with a hamstring tendon autograft was 20% and was not significantly more favorable in comparison with ACL repair with DIS. Although the rate of recurrent instability after ACL reconstruction in the present study was higher than in reports of graft failure after ACL reconstruction with a hamstring tendon graft in comparable age groups (up to 8% 40 , 42 , 45 ), it was within the range of graft failure rates (up to 28.3%) in a recent systematic review of comparative studies by Belk et al, 5 who revealed inconsistency in clinical outcomes at midterm follow-up after ACL reconstruction with hamstring tendon autografts.…”

Risk Factors for Anterior Cruciate Ligament Graft Failure in Professional Athletes: An Analysis of 342 Patients With a Mean Follow-up of 100 Months From the SANTI Study Group

“…Moreover, Guy et al 20 recently found that 37.3% of elite skiers experienced contralateral ruptures. Furthermore, a recent study by Fältström et al 11 identified female soccer players from the Swedish National Knee Ligament Registry and found a 17.8% rate of contralateral ACL injuries. Players who returned to soccer had a 5 times higher risk of contralateral ACL injury than players who did not return.…”

Repeat Anterior Cruciate Ligament Injury and Return to Sport in Australian Soccer Players After Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft

“…63 After ACLR, second ACL injuries occur in 14% to 22% of patients over the first 5 years, 9,27,31,39,47,56,60,62 and a recent study of female Swedish soccer players reported repeat ACL injury rates as high as 42% in those who returned to soccer, at a mean of 6.5 years. 15…”