Return to Sport After Pediatric Anterior Cruciate Ligament Reconstruction and Its Effect on Subsequent Anterior Cruciate Ligament Injury

Dekker, Travis J.; Godin, Jonathan A.; Dale, Kevin; Garrett, William E.; Taylor, Dean C.; Riboh, Jonathan C.

doi:10.2106/jbjs.16.00758

Cited by 220 publications

(267 citation statements)

References 35 publications

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“…In patients desiring to return to sports-particularly level I sports involving jumping, pivoting, and cutting maneuvers-reconstruction of the torn ligament (ACLR) is usually the only viable treatment option to restore adequate joint stability. Such interventions notwithstanding, only 19%-48% of athletes succeed in returning to sports within 12 months [3] and the risk of graft failures or secondary ACL injuries on the contralateral limb is high [4], especially in pediatric cohorts [5].…”

Section: Introductionmentioning

confidence: 99%

Physical Fitness after Anterior Cruciate Ligament Reconstruction: Influence of Graft, Age, and Sex

Csapo

Pointner²,

Hoser

et al. 2020

Sports

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Functional tests are used to facilitate return-to-sports decisions after anterior cruciate ligament reconstruction (ACLR). This study presents comprehensive physical fitness test data acquired in highly active patients within the first year after ACLR, for comparison between different grafts, age groups, and sexes. The outcomes from a specific seven-item test battery and isokinetic strength test data were extracted from a patient database. Results were compared to normative data from age-and sex-matched controls and between subgroups of patients. A total of 245 patients (94 women, 23.8 ± 8.4 years, pre-injury Tegner 7.4 ± 1.6) were tested 185 ± 44 days after surgery. In 116 patients (47.3%), one or more test results were classified as "poor" or "very poor" after comparison with normative data, with failures being most frequent during single-leg squat jump and plyometric strength tests. Test failures were more prevalent in adults than in adolescents <19 years (61.4%-62.2% vs. 24.5%, p < 0.001) and in men (61.6% vs. 24.5%, p < 0.001), but no differences were found between grafts. Isokinetic knee extensor strength was lower by 24.1% on the injured side. Six months after ACLR, nearly 50% of highly active patients presented with strength and functional fitness deficits. These deficits are particularly prevalent in older patients and men.

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Section: Introductionmentioning

confidence: 99%

Physical Fitness after Anterior Cruciate Ligament Reconstruction: Influence of Graft, Age, and Sex

Csapo

Pointner²,

Hoser

et al. 2020

Sports

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“…Therefore, consider advising the child athlete not to return to pivoting sport until at least 12 months following ACL reconstruction. Rehabilitation is also an excellent opportunity to train the uninjured leg, which might be important considering the risk of contralateral injury 38. Once the child returns to sport, a comprehensive injury prevention program, emphasising biomechanical alignment and landing/cutting technique should be integrated with usual training.…”

Section: Consensus Methodsmentioning

confidence: 99%

2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries

et al. 2018

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In October 2017, the International Olympic Committee (IOC) hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. The purpose of this consensus statement was to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America, and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. This consensus statement addresses 6 fundamental clinical questions regarding the prevention, diagnosis, and management of paediatric ACL injuries. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury.

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“…En forma general, los estudios publicados en grupos de pacientes generales muestran un retorno deportivo entre un 44% y un 92%. [5][6][7][15][16][17][18][19][20][21]…”

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Retorno Deportivo Luego de Reconstrucción Primaria de Ligamento Cruzado Anterior con Injerto Hueso-Tendón Patelar-Hueso Autólogo: Análisis de Factores Relacionados

Pakuts

Martín

Contador

2020

Rev Chil Ortop Traumatol

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Objective Analyze return to sports and related factors after primary anterior cruciate ligament reconstruction. Methods Observational descriptive study. 173 patients operated by the same surgeon and standardized technique (patellar autograft) who answered a questionnaire at least 12 months post procedure were included. Questionnaire included Subjective IKDC, Tegner activity level (Pre and Postoperative) and questions elaborated by the group. Results Mean age was 30.8 years, 85% were men, 73% practiced soccer and median postoperative IKDC was 71. Follow up until questionnaire response was 28 months. Males had a better return to sports than females (70% vs 48%, p = 0.037). Tegner pre-injury level was 5 vs 4.3 postoperative, (p < 0.001). Return to sports was 67% according to Tegner scale and 66% by self-assessment. Return to similar previous activity level was 57% by Tegner scale but 24% by direct questions. Of those patients, 51% have fear of re-injury and 26% by reasons other than knee or surgery. We didn't find association between meniscal injuries and return to sports rate. Patients with chondral injuries had lower rates in return to sports (35% vs 60%, p = 0.002). Subjects that returned to sports had higher IKDC scores (73.5 vs 64.3, p < 0.001). Conclusions We found 67% return to sports and 57% to the preinjury level. Positive return to sports factors were male sex, absence of chondral injury and better functional outcome. Psychological factors such as fear of injury is frequent in patients who don't achieve previous levels of activity.

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Return to Sport After Pediatric Anterior Cruciate Ligament Reconstruction and Its Effect on Subsequent Anterior Cruciate Ligament Injury

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 220 publications

References 35 publications

Physical Fitness after Anterior Cruciate Ligament Reconstruction: Influence of Graft, Age, and Sex

Physical Fitness after Anterior Cruciate Ligament Reconstruction: Influence of Graft, Age, and Sex

2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries

Retorno Deportivo Luego de Reconstrucción Primaria de Ligamento Cruzado Anterior con Injerto Hueso-Tendón Patelar-Hueso Autólogo: Análisis de Factores Relacionados

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