Results From the Swedish National Anterior Cruciate Ligament Register

Abstract

Purpose: The purpose of the study was to report baseline variables and clinical outcome for almost 24,000 patients entered into the Swedish national ACL register. Methods:The register consists of two parts; one section in which surgeons report baseline and surgical data and one section in which patients report the Knee injury and Osteoarthritis Outcome Score (KOOS) and the EQ-5D before and one, two and five years after surgery.Results: By December 2012, 23,744 patients had been entered in the surgeons' part of the register. The female/male ratio in the register is 42/58. The mean age at primary ACL reconstruction was 26 (SD 11) and 28 (SD 9) years for the female and male patients respectively. The ACL injury occurred during soccer in 36% of the females and 49% of the males. In 2012, 95% of the primary ACL reconstructions were hamstring tendon autografts.For patients who had a minimum of five years of follow-up, the revision rate was 3.3% and the contralateral reconstruction rate was 3.8%. On all follow-up occasions up to five years, the patients who had undergone revision had a significantly (p<0.001) poorer outcome than those undergoing primary unilateral ACL reconstructions in all KOOS and EQ-5D dimensions.On all follow-up occasions, smokers obtained significantly poorer scores than non-smokers in terms of both the KOOS (p<0.008) and the EQ-5D scores (p<0.024). 3Conclusion: Soccer is the most common cause of injury in both females and males, patients undergoing revisions fare less well than those undergoing primary unilateral ACL reconstructions and smokers fare less well than non-smokers. The cumulative risk of an ACL revision or contralateral ACL reconstruction during a five-year period is approximately 7%.For patients under the age of 19 years, the cumulative risk is significantly higher.Level of Evidence: Level II, Lesser-quality prospective study 4

Functional Performance Among Active Female Soccer Players After Unilateral Primary Anterior Cruciate Ligament Reconstruction Compared With Knee-Healthy Controls

“…The study population was identified through the Swedish national ACL register, which captures >90% of all ACLRs in the country, 22 and via advertisement on the websites of three regional soccer districts near the university (to facilitate testing …”

Long-term quality of life following anterior cruciate ligament injury and reconstruction

“…A range of demographic factors have also been related to worse health-related QOL outcomes within five years of ACLR, these include being a current or previous tobacco smoker (Dunn et al, 2015;Kvist, Kartus, Karlsson, & Forssblad, 2014) having an older age, an increased BMI or having had fewer years of education at the time of ACLR (Dunn et al, 2015). Reporting lower pre-operative knee-related and health-related QOL scores has been associated with reporting lower scores on the same measures postoperatively (Bryant, Stratford, Marx, Walter, & Guyatt, 2008;Dunn et al, 2015).…”

One Anterior Cruciate Ligament injury is enough!: Focus on female football players

“…With delayed ACLR, a significant increase in the number of meniscus and cartilages injuries is observed [61,104]. In Scandinavia, the median time from injury-to-surgery ranged from 7-10 months [72] (median 8 months in Sweden [114]). In the US, the median time was 2.4 months [126].…”

“…The incidence increases severalfold in sports, and is as high as 500-8500/100 000 participants/year in football [221], the main sport in Sweden. The most common sport for both females and males performed at ACL injury and who later undergo ACLR in Sweden is football (36% vs. 49%), and after that alpine skiing (18% vs. 10%), handball (9% vs. 3%) and floorball (8% vs. 10%) [114]. The female-to-male ACL injury rate is different depending on sport.…”

“…In Sweden, approximately half of patients with an ACL injury choose to have ACLR [64] and more than 90% of all ACLRs performed in Sweden are included in the Swedish national ACL register [114]. In the United States (US) orthopaedic surgeons have a strong preference for ACLR -approximately 90-95% of patients with an ACL injury undergo ACLR [126].…”