Summary

Clinical Outcomes of Anterior Cruciate Ligament Reconstruction in Gaelic Athletic Association Players

Abstract

Background

The Gaelic Athletic Association (GAA) sports, specifically Gaelic football and Hurling/Camogie, are high-intensity, level 1 field sports. These traditional and highly popular sports in Ireland have garnered international appeal and are now played worldwide. The combination of rapid change of direction movements, jumping and physical contact ensure that these are high-risk sports for anterior cruciate ligament (ACL) injury. However, few studies have analysed the outcomes of GAA players following ACL reconstruction (ACLR).

Purpose

To analyse the rates of Return to Play (RTP), ACL graft re-injury, contralateral ACL injury and patient-reported outcomes (PROMS) in a cohort of Gaelic footballers and Hurling/Camogie players at 2 years following ACLR.

Design: Cohort study; Level 3 evidence

Methods

A consecutive, prospective cohort of 1891 GAA athletes who underwent primary ACLR between 2014-2018 were included. Patients were enrolled from the caseload of 2 orthopaedic surgeons and followed for 2 years. The rate of RTP, subsequent ACL injury and PROMS were evaluated at 2 years postoperatively. The PROMS evaluated were the Marx score, ACL-Return to Sport after Injury (ACL-RSI), and International Knee Documentation Committee (IKDC) score.

Results

This study included 1891 GAA players and had a follow-up of 93.4% at 2 years post-operatively. The mean age was 23 +/- 6.0 years and 73.3% of athletes were male. Most initial ACL injuries were non-contact (62.7%) and occurred during competition/match play (74.4%). RTP rates were 87.8% for Gaelic football and 89.5% for Hurling/Camogie, with 72.7% and 76.3% returning to an equivalent or higher level of performance, respectively. The RTP rate was lower in females compared to males (83.8% (249/297) vs. 89.1% (847/951), p < .016). The mean time to RTP was 10.8 +/- 4.0 months and was similar for both sports. The rate of Bone-patellar-tendon-bone (BPTB) autograft re-injury was 3.3% (51/1547) vs. 15.3% (33/216) for Hamstring (HT) autografts (p < .001). Gaelic footballers and Hurling/Camogie players reported good outcomes with mean IKDC scores of 86.9 +/- 9.8 vs. 87.9 +/- 8.9, (p = .064), mean Marx scores of 11.0 +/- 4.7 vs. 11.3 +/- 4.6 (p = .309) and mean ACL-RSI scores of 74.1 +/- 23.5 vs.75.8 +/- 24.2 (p = .321).

Conclusions

The RTP rate for GAA players was high with the majority returning to an equivalent or higher level of performance. Female athletes had slightly lower rates of RTP. The rate of BPTB re-injury was low considering the injury risk associated with a high rate of return to a level 1 sport. Younger patients and those who underwent HT autograft reconstruction were at the highest risk of ACL graft re-injury. There was no difference in contralateral ACL injury between genders or graft types. Overall, GAA players reported good knee function and outcomes after ACLR.