Summary: High rates of return to play are possible with ACLR in elite athletes to the same or higher level but recurrent effusions and further interventions prolong RTP time, and using the AMB femoral tunnel position and adding LET reduces graft re-rupture rates.

Background

Following ACL reconstruction (ACLR), main concerns of athletes are whether they will be able to return to their sport and how quickly, and the risk of needing revision. We report the return to play (RTP) rates and times in elite sports and the factors affecting them, and graft failure rates.

Methods

A consecutive series of primary ACLR in elite athletes (defined as playing professional sport or top-level amateur sport) between January 2005 and June 2018 were retrospectively reviewed. Academy footballers (<17 years) and rugby players (<18 years), those with other knee ligament surgery, or with less than 2 years follow up were excluded. Variables including age, surgical technique, concomitant injuries and subsequent interventions were analysed for their effect on RTP rates, time to return and re-rupture. RTP was defined as the time between ACLR and first professional game.

Results

376 athletes were included with 24 (6.4%) of these receiving bilateral ACLRs. 229 were footballers, 115 rugby players and 56 other sports. Mean age at operation was 23.1 years. 88% of footballers and 90.4% of rugby ACLRs were male compared to 37.5% in the other sports group. 71.3% of knees had new meniscal damage. 17.4% of rugby players also had ICRS grade 3 / 4 chondral lesions compared to 10.5% in footballers and 5.4% in other sports.
58% of ACLR were performed using hamstring (HS) autografts, 41.8% had patellar tendon (PT) autografts and one case, at the player’s insistence, had an allograft. The operative technique evolved: between 2010 and 2013 (114 knees) the femoral tunnel was drilled in the “anatomic” central femoral footprint position rather than the anteromedial bundle (AMB) position (286 knees). 68.9% had a lateral extra-articular tenodesis (LET) in the last 3 years of the study compared to 23% of knees overall.
Rugby (91.3%) had the lowest RTP rate compared to football (95.6%) and other sports (98.2%). Footballers aged under 25 years had a significantly higher RTP rate compared to the older group (99.3% vs 90.2, p=0.001) whereas in rugby and other sports RTP was greater in the older age group (92.9% vs 90.4% and 100% vs 97.5% respectively).
The mean RTP time was fastest for rugby players (9.5 months vs 10.5 in football and 10.7 in other sports) and was longer in athletes receiving PT grafts (10.9 vs 9.8), those with concomitant meniscal injuries (10.5 vs 9.6), post- operative recurrent effusions (11.1vs 10.0) and those undergoing further surgery before RTP (12.8 vs 9.6).
Re-rupture occurred in 6 (5 football, 1 rugby) cases prior to RTP and only one, a footballer, failed to RTP following revision ACLR. LET and AMB femoral tunnel position did not affect RTP but did reduce re-rupture rates (4.4% vs 8.8% and 6.6% vs 10.5% respectively).

Conclusion

Between 91-98% of elite athletes in a wide range of sports will return to professional sport with the time to RTP being affected by several factors. Recurrent effusions and further interventions prolonged RTP time. Using the AMB femoral tunnel position and adding LET reduces graft re-rupture.

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Tranexamic Acid Has No Effect On Post-Operative Hemarthrosis Or Pain Control Following Acl Reconstruction Using Bone Patella Tendon Bone Autograft: A Double-Blinded Randomized Control Trial Abstract Presentation 5 minutes Jordan W Fried, BM, UNITED STATES David Bloom, BA, UNITED STATES Eoghan T. Hurley, MB, BCh, MCh, IRELAND Samuel Baron, MD, UNITED STATES Kirk Anthony Campbell, MD, UNITED STATES Eric Jason Strauss, MD Laith M. Jazrawi, MD, UNITED STATES Michael J Alaia, MD, UNITED STATES
Ligamentous Laxity, Male Sex, Chronicity, Meniscus Injury And Posterior Tibial Slope Are Associated With A High-Grade Pre-Operative Pivot Shift: A Post Hoc Analysis Of The Stability Study Abstract Presentation 6 minutes Lachlan Batty, FRACS, AUSTRALIA Andrew Firth, PhD, CANADA Gilbert Moatshe, MD, PhD, NORWAY Dianne M. Bryant, PhD, CANADA S. Mark A. Heard, MD, FRCS, CANADA Robert G. McCormack, MD, CANADA Alex Rezansoff, MD, FRCSC, CANADA Devin Clarke Peterson, MD, FRCSC, Dip Sport Med, CANADA Davide Bardana, MD, CANADA Peter B. MacDonald, MD, FRCS, Dip Sport Med, CANADA Tim Spalding, FRCS(Orth), UNITED KINGDOM Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR
Impingement Due to Graft Buckling Is More Prevalent after ACL Reconstructions with an Adjustable-Loop Compared to a Fixed-Loop Abstract Presentation 5 minutes Julian De Rover, NETHERLANDS Inge Van Den Akker-Scheek, PhD, NETHERLANDS Hugo Christiaan van der Veen, MD, PhD, NETHERLANDS
Creating A Crosswalk For Knee Outcomes After ACLR From The KOOS(5) To The IKDC-SKF Abstract Presentation 6 minutes Jessica L. Johnson, DPT, PhD, UNITED STATES Aaron Boulton, PhD, UNITED STATES Kurt Paul Spindler, MD, UNITED STATES Laura J. Huston, MS, UNITED STATES Tim Spalding, FRCS(Orth), UNITED KINGDOM Laura Asplin, UNITED KINGDOM May Arna Risberg, PT, PhD, NORWAY Lynn Snyder-Mackler, PT, ScD, FAPTA, UNITED STATES
Combined ACL and Anterolateral Ligament Reconstruction Confers Significantly Improved Long Term Outcomes when Compared to Isolated ACL Reconstruction: A Matched-Pair Analysis Abstract Presentation 5 minutes Adnan Saithna, MD, FRCS, UNITED STATES Ibrahim Haidar, MD, LEBANON Johnny Rayes, MD, MSc, FEBOT, CANADA Thomas Fradin, MD, FRANCE Cédric Ngbilo, MD, SWITZERLAND Benjamin Freychet, MD, FRANCE Thais Dutra Vieira, MD, FRANCE Herve Ouanezar, MD, UNITED ARAB EMIRATES Bertrand Sonnery-Cottet, MD, PhD, FRANCE
Return To Sports After Paediatric Anterior Cruciate Ligament Reconstruction (ACLR): Normal Population Vs An ACLR Cohort Abstract Presentation 6 minutes Alexander S. Nicholls, MSc, FRACS, AUSTRALIA Jillian Lee, BHB, MBChB, FRACS (Ortho), NEW ZEALAND Yoong Lim, BEng, PhD, AUSTRALIA Quang Dao, FRACS, AUSTRALIA
Adding A Lateral Extra-Articular Tenodesis Significantly Reduces Acl Graft Rupture Rates In Pediatric And Adolescent Patients When Compared To Isolated Acl Reconstruction Abstract Presentation 5 minutes Andrea Ferretti, Prof., ITALY Adnan Saithna, MD, FRCS, UNITED STATES Alessandro Carrozzo, MD, ITALY Alessandro Annibaldi, MD, ITALY Fabio Marzilli, MD, ITALY Edoardo Monaco, MD, ITALY
Acl Deficiency Influences Medio-Lateral Tibial Alignment And Knee Varus–Valgus During In Vivo Activities Abstract Presentation 3 minutes Piero Agostinone, MD, ITALY Stefano Di Paolo, Eng, PhD, ITALY Alberto Grassi, PhD, ITALY Marco Bontempi, PhD, ITALY Erika Pinelli, MsC, ITALY Laura Bragonzoni, Prof., ITALY Stefano Zaffagnini, MD, Prof., ITALY
Quadriceps Tendon Autograft Has Lower MRI Signal Than Hamstring Tendon Autograft In Anterior Cruciate Ligament Reconstructions Of Adolescent Athletes Abstract Presentation 5 minutes David Alcoloumbre, MD, UNITED STATES Alexandra Hunter Aitchison, UNITED STATES Douglas Mintz, MD, UNITED STATES Frank A. Cordasco, MD, MS, UNITED STATES Daniel W. Green, MD, MS, UNITED STATES
Coach Education Improves Implementation Of ACL Injury Prevention Programs: A Cluster-Randomized Controlled Trial Abstract Presentation 5 minutes Daphne Ling, PhD, MPH, TAIWAN Caroline Boyle, UNITED STATES Brandon Schneider, MS, UNITED STATES Joseph Janosky, DrPHc, MS, PT, ATC, UNITED STATES James Kinderknecht, UNITED STATES Robert G. Marx, MD, UNITED STATES
Second-Look Arthroscopic Evaluation And Clinical Outcomes After Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction With Generalized Joint Laxity Or Hyperextended Knee Abstract Presentation 6 minutes Yasunari Oniki, MD, PhD, JAPAN Taiki Murakami, JAPAN Eiichi Nakamura, MD, PhD, JAPAN

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Return To Elite Sport After ACL Reconstruction In 376 'Professional' Athletes

Return To Elite Sport After ACL Reconstruction In 376 'Professional' Athletes

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Return To Elite Sport After ACL Reconstruction In 376 'Professional' Athletes

Return To Elite Sport After ACL Reconstruction In 376 'Professional' Athletes

Background

Methods

Results

Conclusion

More ISAKOS 2021: Global Content