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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Quantitative Evaluation of Lateral Articular Cartilage Quality on Magnetic Resonance Imaging at 2-years following Anterior Cruciate Ligament Reconstruction With Or Without A Lateral Extra-Articular Tenodesis Abstract Presentation 6 minutes Andrew Firth, PhD, CANADA Dianne M. Bryant, PhD, CANADA Jaques Milner , CANADA Stephany Pritchett, MD, FRCPC, DABR, CANADA David Holdsworth, PhD, Canada Stability Study Group, CANADA Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR
Acl - Pcl Fixation Sequence During Multi-Ligament Knee Reconstruction Does Not Affect Knee Laxity Abstract Presentation 6 minutes Carola F. van Eck, MD, PhD, FAAOS, UNITED STATES Aly Maher Fayed, MD, EGYPT Ryo Kanto, MD, JAPAN Taylor M. Price, MS, UNITED STATES Michael Dinenna, BS, UNITED STATES Monica A. Linde, MSIE, RN, UNITED STATES Patrick J. Smolinski, PhD, UNITED STATES
Bone Marrow Aspiration Concentrate Augmentation in Anterior Cruciate Ligament Hamstring Autograft Reconstruction: Clinical and Functional Outcomes of a Cohort Study Abstract Presentation 5 minutes David H. Figueroa, MD, CHILE Rodrigo Guiloff, MD, Prof, CHILE Sergio Arellano, MD, CHILE Alex Vaisman, MD, Prof., CHILE Francisco Figueroa, MD, CHILE Nicolas Zilleruelo, MD, CHILE Rafael Calvo, MD, CHILE
Comparison of three different Quadriceps Tendon ACL graft to BTB and Semi-T grafts: A biomechanical study ePoster Presentation Marc Jacob Strauss, MD, NORWAY Jonathan Miles, M.S, UNITED STATES Mitchell Iung Kennedy, BS, UNITED STATES Gilbert Moatshe, MD, PhD, NORWAY Grant J Dornan, MS, UNITED STATES Martin Lind, MD, PhD, Prof., DENMARK Lars Engebretsen, MD, PhD, NORWAY Robert F. LaPrade, MD, PhD, UNITED STATES
Early Return To Sport After Quadriceps Tendon Autograft ACL Reconstruction: Comparison To Bone-Patellar Tendon-Bone Autograft At A Minimum 1-Year Follow-Up ePoster Presentation Evan W. James, MD, UNITED STATES Dakota Adamec , BS , UNITED STATES Spencer Sullivan, BS, UNITED STATES Per-Henrik Randsborg, MD, PhD, NORWAY Brandon Schneider, MS, UNITED STATES Robert G. Marx, MD, UNITED STATES Answorth A. Allen, MD, UNITED STATES Frank A. Cordasco, MD, MS, UNITED STATES Benedict U. Nwachukwu, MD, MBA, UNITED STATES Danyal H. Nawabi, MD, FRCS(Orth), UNITED STATES
A Comparison of Lower Limb Strength and Plyometric Ability in Athletes who underwent ACLR with Lateral Extra-Articular Ilio-Tibial Band Tenodesis when compared with Isolated ACLR Surgery. A Biomechanical Study. Abstract Presentation 7 minutes Bláithín Brady, BSc MSc , IRELAND Sarah Crosbie, BSc, IRELAND Neil Welch, BSc MSc PhD, IRELAND Mihai Vioreanu, MD, MCh, FFSEM, FRCSI(Tr&Orth), IRELAND
Quadriceps Tendon Vs. Hamstring Tendon Autograft In Primary Anterior Cruciate Ligament Reconstruction: A Matched-Pairs Study With A Mean Follow-Up Of 6.5 Years Award Winner 5 minutes Armin Runer, PD MD, GERMANY Aline Suter, MD, AUSTRIA Tommaso Roberti di Sarsina, MD, ITALY Caroline Hepperger, PhD, AUSTRIA Peter Gföller, MD, AUSTRIA Christian Hoser, MD, AUSTRIA Robert Csapo, PhD, AUSTRIA Christian Fink, MD, Prof., AUSTRIA
In Vivo Measurement of Anterior Cruciate Ligament Elongation and Strain Rate during Increasingly Demanding Activities ePoster Presentation Kyohei Nishida , MD, PhD, JAPAN Caiqi Xu, MD, CHINA Tom Gale, MS, UNITED STATES William Anderst, PhD, UNITED STATES Freddie H. Fu, MD, UNITED STATES
Negative Effects Of Delayed Anterior Cruciate Ligament Reconstruction On Associated Injuries And Knee Laxity Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Per-Mats Janarv, MD, PhD, Associate Prof., SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN Gunnar Edman, MD, PhD, Prof., SWEDEN Magnus Forssblad, SWEDEN Anders Stalman, MD, PhD, Professor, SWEDEN
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

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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