Context: The risk factors for anterior cruciate ligament (ACL) tear for athletes participating in pivoting sports includes young age and female sex. A previous meta-analysis has reported a reinjury rate of 15% after ACL reconstruction (ACLR) for athletes across all sports. To the best of the authors’ knowledge, this is the first systematic review and meta-analysis of available literature reporting outcomes after ACLR in soccer players. Objective: To review and aggregate soccer-specific outcomes data after ACLR found in current literature to help guide a more tailored discussion regarding expectations and prognosis for soccer players seeking operative management of ACL injuries. Data Sources: A comprehensive search of publications was performed using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and SPORTDiscus databases. Study Selection: Inclusion criteria consisted of original studies, level of evidence 1 to 4, studies reporting clinical and patient-reported outcomes (PROs) after primary ACLR in soccer players at all follow-up length. Study Design: The primary outcomes of interest were graft failure/reoperation rates, ACL injury in contralateral knee, return to soccer time, and PROs. Level of Evidence: Level 4. Data Extraction: Search of literature yielded 32 studies for inclusion that involved 3112 soccer players after ACLR. Results: The overall graft failure/reoperation rate ranged between 3.0% and 24.8% (mean follow-up range, 2.3-10 years) and the combined ACL graft failure and contralateral ACL injury rate after initial ACLR was 1.0% to 16.7% (mean follow-up range, 3-10 years); a subgroup analysis for female and male players revealed a secondary ACL injury incidence rate of 27%, 95% CI (22%, 32%) and 10%, 95% CI (6%, 15%), respectively. Soccer players were able to return to play between 6.1 and 11.1 months and the majority of PROs showed favorable scores at medium-term follow-up. Conclusion: Soccer players experience high ACL injury rates after primary ACLR and demonstrated similar reinjury rates as found in previous literature of athletes who participate in high-demand pivoting sports.
Introduction: Patellar and quadriceps tendon ruptures after total knee arthroplasty (TKA) have historically poor outcomes. To date, there is no consensus for optimal treatment. The purpose of this study is to directly compare clinical outcomes and survivorship between allograft versus synthetic mesh for reconstruction of native extensor mechanism (EM) rupture after TKA. Methods: A multicenter, retrospective review identifying consecutive TKA patients operated between December 2009 to November 2019 was conducted. Patients aged $ 45 years old with native EM disruption treated with either allograft or synthetic mesh with minimum 2 year follow-up were included. Demographic information, injury mechanism, range of motion, surgical time, revision surgeries, and postoperative Knee Injury and Osteoarthritis Outcome Scores (KOOS Jr.) were collected. Student t-tests and Fisher exact tests were used to compare the demographic data between groups. The Kaplan-Meier survival curve method was used to determine the survivorship as treatment failure was defined as postoperative EM lag .30°or revision surgery. Survival curves were compared using the log-rank test. Univariate Cox proportional hazard regression identified risk factors associated with treatment failure. Results: Twenty patients underwent EM reconstruction using allograft versus 35 with synthetic mesh. Both groups had similar demographics and an average follow-up time of 3.5 years (P = 0.98). Patients treated with allograft had significantly greater postoperative flexion than patients treated with mesh (99.4 6 9.5 allograft versus 92.6 6 13.6 synthetic mesh, P = 0.04). Otherwise, there was no difference in postoperative outcomes between the two groups in average KOOS Jr. (P = 0.29), extensor lag (P = 0.15), graft failure (P = 0.71), revision surgery rates (P = 0.81), surgical time (P = 0.42), or ambulatory status (P = 0.34) at the most recent follow-up. Survival
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