Rates and Levels of Elite Sport Participation at 5 Years After Revision ACL Reconstruction

Abstract

Background: There is a paucity of data regarding return to play (RTP), level of competition, and longevity of play after revision of anterior cruciate ligament (ACL) reconstruction (ACLR) in elite athletes. Purpose: To report RTP rates and competition levels in elite athletes at the point of RTP, as well as at 2 and 5 years after revision ACLR, and the effect of meniscal and chondral pathology at revision surgery on these outcomes. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of a consecutive series of all revision ACLRs undertaken by the senior author between 2009 and 2019, with a minimum 2-year follow-up, was carried out. Outcome measures were RTP rates and competition level. Results: A total of 49 knees in 48 elite athletes met the inclusion criteria. After revision ACLR, 43 (87.8%) elite athletes achieved RTP, of whom 75.5% were at the same level. At 2 years after surgery, 39 (79.6%) were still playing, 25 (51%) at the same level; at 5 years after surgery, 20 (44.4%) were still playing, 9 (20%) at the same level. Elite athletes with <50% thickness or no articular cartilage lesions were more likely to RTP (94.6% vs 66.7%; P = .026), as well as return to the same competition level (83.8% vs 50%; P = .047), compared with those with ≥50% thickness chondral lesions. Those without medial meniscal pathology were more likely to RTP at the same level after revision surgery (94.4% vs 64.5%; P = .036). The median time elite athletes continued to play after revision ACLR was 73 months (95% CI, 43.4-102.6); 23 months at the same level (95% CI, 13.6-32.4). The probability of still playing at 5 years after surgery was 55.9%, with a 22.5% chance of maintaining preinjury competition level. Conclusion: In elite athletes, RTP rates and competition level decreased over time after revision ACLR. The presence of >50% thickness chondral pathology was associated with lower RTP rates and competition level at RTP time, while medial meniscal pathology was associated with lower competition level at RTP.

Quadriceps tendon autograft has similar clinical outcomes when compared to hamstring tendon and bone–patellar tendon–bone autografts for revision ACL reconstruction: a systematic review and meta‐analysis

“…Finally, the cumulative failure rate for QT of 7.6%, is comparable to previous RACLR failure rates ranging from 6% to 13.7% [40, 66]. The high rates of concomitant procedures and associated internal derangement should be taken into account when contextualizing the outcomes reported within this study, as chondral injury and medial meniscal injury have been associated with decrease return to play after RACLR [48].…”

Determinants of Performance in Professional Soccer Players at 2 and 5 Years After ACL Reconstruction

“…In a previous study, 4 there was also no delay in RTP in cases with additional LET. The benefits of LET when treating elite athletes with an ACL injury are clear, given the deleterious career consequences of ACL rerupture 32 combined with the increased risk of osteoarthritis from any persisting anterolateral instability after ACLR. Our study reinforces the status as professional soccer players as a potential indication for LET, as it better predicts performance rates at 2 years after ACLR.…”

Limb asymmetries persist 6 months after anterior cruciate ligament reconstruction according to the results of a jump test battery

“…Ruptures to the anterior cruciate ligament (ACL) are among most frequently encountered injuries in subjects practicing cutting and pivoting sports and in active patients experiencing knee instability is usually addressed surgically ( 1 , 2 ).…”