Return to Play and Future ACL Injury Risk After ACL Reconstruction in Soccer Athletes From the Multicenter Orthopaedic Outcomes Network (MOON) Group

Abstract

Background There is limited information on outcomes and return to play (RTP) after ACL reconstruction (ACLR) in soccer athletes. Hypothesis The purpose of this study was to (i) test the hypotheses that player sex, side of injury and graft choice do not influence RTP, and (ii) define the risk for future ACL injury in soccer players after ACLR. Study design Retrospective cohort study, Level II. Methods Soccer players in a prospective cohort were contacted to determine RTP following ACLR. Information regarding if and when they returned to play, their current playing status, the primary reason they stopped playing soccer (if relevant) and incidence of subsequent ACL surgery was recorded. Results Initially, 72% of 100 soccer athletes (55 male, 45 female) with a mean age of 24.2 years at the time of ACL reconstruction returned to soccer. At average follow up of 7.0 years, 36% were still playing, a significant decrease compared to initial RTP (p<0.0001). Based on multivariate analysis, older athletes (p=0.006) and females (p=0.037) were less likely to return to play. Twelve soccer athletes had undergone further ACL surgery, including 9 on the contralateral knee and 3 on the ipsilateral knee. In a univariate analysis, females were more likely to have future ACL surgery (20% v. 5.5%, p=0.03). Soccer athletes who underwent ACLR on their non-dominant limb had a higher future rate of contra-lateral ACLR (16%) than soccer athletes who underwent ACLR on their dominant limb (3.5%) (p=0.03). Conclusion Younger and male soccer players are more likely to return to play after ACL reconstruction. Return to soccer following ACLR declines over time.

Return to sport following anterior cruciate ligament reconstruction

“…Despite many reports of successful outcomes following ACL reconstruction, recent reports have suggested that the rates of return to sport may not match the success of this surgery as measured by other factors [2,4,5,10,13,19,25,31,44]. This discrepancy raises many issues and the purpose of this article is to explore return to sport following ACL reconstruction from a number of perspectives.…”

“…Mascarenhas et al found that 50 % of young (25 years or less at the time of ACL reconstruction) athletes returned to their pre-injury sport at some stage following surgery [31]. Brophy et al reported that at a mean follow-up of seven years 36 % of soccer players were still playing compared to the 72 % that had resumed play at some time following their ACL reconstruction [10]. Similarly, Struewer et al reported that the participation rate in pivoting and contact sports decreased from 78 % at two years to 45 % at 13.5 years, and for competitive sport from 65 % to 19 % [44].…”

Return to Sport after Anterior Cruciate Ligament Reconstruction: A Literature Review

“…In the U.S, ACL injury rate is almost 1 in 3500 individuals every year [1] which is calculated to approximately 125000 to 200000 ACL reconstructions yearly. Many studies have examined the injury rate in football and they reported that from all injuries, 60% to 80% occur in lower extremities [2][3][4]. Most of these injuries are knee or ankle related 29% and 19% respectively [2].…”

“…Most of these injuries are knee or ankle related 29% and 19% respectively [2]. From these knee injuries Anterior Cruciate Ligament (ACL), Posterior Cruciate Ligament (PCL) and Medial Collateral Ligament (MCL) are considered to be most frequent and severe [3,4]. possibilities to get reinjured than patients of an older age.…”

“…All the above rates look to decrease even more with time. Brophy et al [3] reported that 72% of their athletes resumed to play after ACL reconstruction and at 7 years follow up only 36% of those athletes were still playing soccer. Another study examining an even longer follow-up showed that the rate of participation in competitive pivoting sports went down from 65% at 2 years after ACL surgery to only 19% at 13.5 years follow-up [55].…”