After revision anterior cruciate ligament reconstruction, who returns to sport? A systematic review and meta-analysis

Grassi, Alberto; Zaffagnini, Stefano; Muccioli, Giulio Maria Marcheggiani; Neri, Maria Pia; Villa, S.; Marcacci, Maurilio

doi:10.1136/bjsports-2014-094089

Cited by 70 publications

(60 citation statements)

References 42 publications

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“…Regardless of treatment, the RTS rate is affected by factors including specific sport demands and regional differences 15 35. RTS rates are lower after revision ACL reconstruction than after primary surgery 36 37. The length of time taken to RTS after ACL injury is variable, although only a minority of athletes have returned to their preinjury level 1 year after surgical reconstruction 38.…”

Section: Section 3: What Evidence Do We Have To Inform the Clinician'mentioning

confidence: 99%

2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern

et al. 2016

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Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athlete's return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport

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Section: Section 3: What Evidence Do We Have To Inform the Clinician'mentioning

confidence: 99%

2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern

et al. 2016

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“…Despite an overall reduction in patient expectations for revision ACLR compared to the very high expectations reported prior to primary ACLR, 96% of patients expect no risk or a slightly increased risk of developing osteoarthritis (compared to a healthy knee) 10 years following revision ACLR, 88% percent expect to return to the same level of sport, and all patients expect to have a normal or nearly normal knee after revision surgery (Feucht et al, 2014). In contrast to these expectations, only one in every two patients return to pre-injury sport following revision ACLR (Grassi et al, 2015) and reported rates of knee osteoarthritis four to eight years after revision ACLR range from 37% to 80% (Kamath, 2011).…”

Section: Subsequent Injury and Revision Surgerycontrasting

confidence: 38%

Long-term quality of life following anterior cruciate ligament injury and reconstruction

Filbay¹

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The anterior cruciate ligament (ACL) serves to stabilise the knee complex and prevent intraarticular knee structures from sustaining damage during multiaxial, high impact movement. An ACL rupture most commonly occurs in adolescents and young adults taking part in competitive sports and causes substantial disruption to the knee joint. Anterior cruciate ligament reconstruction (ACLR) is the most common treatment offered to ACL-ruptured individuals worldwide. Individuals undergoing this surgery often have high expectations that rarely match surgical outcomes. Return to sport rates are low, re-injury fears are widespread and many individuals develop knee osteoarthritis within ten years of ACLR. This mismatch between expectations and actual outcomes has great potential to impact longer-term quality of life (QOL). The primary aims of this thesis were to: (i) generate a detailed picture of longer-term QOL following ACLR, and (ii) identify factors related to longer-term QOL in people with knee pain, symptoms or functional limitations following ACLR.The first study in this thesis is a systematic review that revealed impaired knee-related QOL at 5 to 20 years after ACLR. However, it became evident that research into factors impacting upon QOL in this population was scarce. The systematic review found that having a subsequent knee injury, an additional knee surgery after ACLR, and developing severe radiographic osteoarthritis were associated with worse QOL outcomes. The second study in this thesis is a systematic review that investigated QOL more than five years after ACL rupture in individuals who remained ACL-deficient (did not undergo ACLR) and compared QOL between ACLdeficient and ACL-reconstructed groups. This systematic review found that ACL-deficient individuals reported comparable QOL outcomes to those who underwent ACLR 5 to 25 years previously. All studies that reported QOL after ACLR included asymptomatic participants without knee difficulties, which may underestimate the degree of QOL impairment experienced by people with ongoing knee difficulties.The third study in this thesis used a cross-sectional design to describe QOL outcomes in 162 individuals with knee pain, symptoms or functional limitations 5 to 20 years following ACLR.It showed that individuals who did not return to sport after ACLR reported poorer knee-related and health-related QOL, compared to people who returned to pre-injury levels of sport. Higher body mass index (BMI) and subsequent surgery were also related to worse QOL after ACLR.This was the first study to show that return to sport was associated with QOL impairment more than five years after ACLR. However, quantitative assessment of QOL may overlook important considerations with regard to an individual's life priorities, expectations, values and concerns.To provide a detailed understanding of QOL following ACLR, qualitative interviews were performed with 17 individuals with knee difficulties 5 to 20 years following ACLR. This was the first qualitative study to explore QOL following...

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“…Andriolo et al 17 reported that 57% of patients after revision surgery did not return to the same level of sports activity, which was significantly inferior to that of those after primary reconstruction. Grassi et al 18 also reported that, in spite of almost 80% of patients returning to sports after revision ACL surgery and showing good stability, only half of the patients returned to the same preinjury sport level. Regarding prognostic factors after revision ACL surgery, a recent study from the MARS group revealed that prior lateral meniscectomy and current grade 3–4 changes of the trochlear cartilage were associated with worse outcomes in terms of decreased sports participation, more pain, more stiffness and more functional limitation at 2 years after revision surgery 21…”

Section: Current State Of the Artmentioning

confidence: 99%

“…Eleven review articles were identified from the past 10 years on the topic of revision ACL surgery and related subjects. Five reviews focused on risks and causes of primary ACL reconstruction failure,8 10–13 four on indications/strategies and techniques of revision surgeries,8 10 14 15 and four on clinical outcomes;16–19 two of them focused on return to sports 17 18. In addition, one recent article described strategies for revision surgery after primary double-bundle (DB) ACL reconstruction 20.…”

Section: Introductionmentioning

confidence: 99%

Revision anterior cruciate ligament surgery: state of the art

Koga

Engebretsen

et al. 2017

Journal of ISAKOS

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After revision anterior cruciate ligament reconstruction, who returns to sport? A systematic review and meta-analysis

Cited by 70 publications

References 42 publications

2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern

2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern

Long-term quality of life following anterior cruciate ligament injury and reconstruction

Revision anterior cruciate ligament surgery: state of the art

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