Does sex affect second ACL injury risk? A systematic review with meta-analysis

Patel, Akash D; Bullock, Garrett S.; Wrigley, Jordan; Paterno, Mark V.; Sell, Timothy C.; Losciale, Justin M

doi:10.1136/bjsports-2020-103408

Cited by 24 publications

(23 citation statements)

References 86 publications

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“…One of the major concerns after a primary ACL rupture is to avoid a second injury. According to a recent systematic review, both sexes are at > 20% increased risk of experiencing a second ACL injury [ 25 ]. Injuries to the ipsilateral graft are more common than contralateral ACL, with ipsilateral graft injuries occurring nearly 16 months earlier after ACLR [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

“I don't opt out of things because I think I will get a sore knee, but I don't expose myself to stupid risks either”: patients’ experiences of a second ACL injury—an interview study

Heijne

Silbernagel

Lundberg

2021

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this qualitative study was to describe women’s experiences with anterior cruciate ligament reconstruction (ACLR) and a subsequent ACL rupture, and to identify potential facilitators and barriers for coping with rehabilitation after the second injury. Methods Eight women between 17 and 36 years (mean 26, SD 6.5) who had experienced ACLR, followed by another ACL rupture, participated in the study. Semi-structured interviews were conducted, and data were analyzed using qualitative content analysis. Results One overarching theme, “Rehabilitation after a second ACL injury—A lifelong adaptive coping process”, emerged from analyses. Undergoing a second rehabilitation is described as a process of adaptation, beginning with the first injury and still ongoing, more than 5 years later. Participants applied different coping strategies to adapt to these life-altering injuries, but the common denominator was of major life adjustments with no return to previous activity levels. Initially, after the reinjury, it was about coping with the catastrophe of the dreaded second injury. Over time, they accepted their “new” life and reset their recovery/rehabilitation goal not just as “return to sport” but rather as a “personal life goal”. Conclusion Undergoing a second ACL injury is a long process that challenges the patient’s coping skills. Given these results, rehabilitation programs need to be more person centred according to the patients-adjusted life goals. Level of evidence 3.

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Section: Introductionmentioning

confidence: 99%

“I don't opt out of things because I think I will get a sore knee, but I don't expose myself to stupid risks either”: patients’ experiences of a second ACL injury—an interview study

Heijne

Silbernagel

Lundberg

2021

Knee Surg Sports Traumatol Arthrosc

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Section: Discussionmentioning

confidence: 99%

“…Although the cause of this imbalance is unclear, it is a consistent finding across the literature that male athletes experience a greater proportion of graft ruptures compared with contralateral ACL injuries. 17 A limitation of the current study was the inclusion of only male football players. Although the start of the women's professional competition (Australian Football League Women's; AFLW) in 2017 has seen a rapid growth in the number of girls and women participating in communitylevel Australian football, during the time data for the current study were collected, there were only 30 women (compared with 491 men) who underwent ACL reconstruction and listed Australian football as their primary sport.…”

Section: The Orthopaedic Journal Of Sports Medicinementioning

confidence: 99%

Rates and Determinants of Returning to Australian Rules Football in Male Nonprofessional Athletes After Anterior Cruciate Ligament Reconstruction

Webster

Klemm

Feller

2022

Orthopaedic Journal of Sports Medicine

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Background: Return to sport is a goal for most patients who undergo anterior cruciate ligament (ACL) reconstruction. However, at a nonelite level, there are limited sport-specific data regarding rates or factors associated with return to play. Purpose: To report rates and determinants of returning to play Australian Rules football after ACL reconstruction in male nonprofessional athletes. Study Design: Case-series; Level of evidence, 4. Methods: A total of 354 male nonprofessional Australian Rules football players who had undergone primary ACL reconstruction were asked to complete detailed sports activity questions at 12 months and 2 to 5 years (mean, 3 years) after surgery. Rates of return to play were calculated for both timepoints, along with preoperative patient expectations and postoperative sport performance. The following predictors of return to play were examined: age at surgery; height; weight; frequency of weekly football participation; sport participation level; psychological readiness to return to sport; and knee-related quality of life. Further ACL injuries were also documented. Descriptive statistics were used to summarize return-to-play data and contingency analysis for predictors of return to sport. Results: The rate of return to any level of play was 35% (95% CI, 30%-41%; n = 284) at the 12-month follow-up and 78% (95% CI, 72%-83%; n = 233) at the 2- to 5-year follow-up. Overall, 64% (95% CI, 57%-70%) of the patients were able to return to their same or higher level of play. Before surgery, 92% of the patients expected to return to their same preinjury level of Australian Rules football participation. At the 2- to 5-year follow-up, 61% who returned to play felt that they could perform as well as they could before their ACL injury. A greater psychological readiness to return to sport preoperatively and higher level of sport participation were significant predictors of a return at 2 to 5 years. Further ACL injuries were sustained by 21% of the cohort (15% graft rupture; 6% contralateral ACL injury). Conclusion: Most male athletes who participate in Australian Rules football returned to some level of play after ACL reconstruction; however, only 64% returned to preinjury levels. Preoperative expectations were not met, and high reinjury rates are a cause for concern.

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“…This should be taken into consideration when making rehabilitation and return to activity decision making and indicates that the mean return to activity time after ACLR should be extended to reflect these findings. 17 After an initial injury, ACL injury risk is increased 31 by more than 20%. This rate of reinjury may be an indication that patients are returning to high-level activities before they are prepared in a manner that minimizes reinjury risk.…”

Section: Discussionmentioning

confidence: 99%

“…After an initial injury, ACL injury risk is increased 31 by more than 20%. This rate of reinjury may be an indication that patients are returning to high-level activities before they are prepared in a manner that minimizes reinjury risk.…”

Section: Discussionmentioning

confidence: 99%

Disagreement in Pass Rates Between Strength and Performance Tests in Patients Recovering From Anterior Cruciate Ligament Reconstruction

et al. 2022

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Background: Performance on strength and functional tests is often used to guide postoperative rehabilitation progress and return to activity decisions after anterior cruciate ligament reconstruction (ACLR). Clinicians may have difficulty in determining which criteria to follow if there is disagreement in performance outcomes among the tests. Purpose/Hypothesis: The purpose of this study was to compare pass rates between strength tests and single-leg hop (SLHOP) tests among men and women and between patients with lower and higher preinjury activity levels recovering from ACLR. We hypothesized that pass rates would be nonuniformly distributed among test types, sex, and activity level and that more participants would pass hop tests than strength tests. Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 299 participants (146 men; 153 women)—at a mean of 6.8 ± 1.4 months after primary, unilateral, and uncomplicated ACLR (mean age, 23 ± 9.7 years; mean height, 172 ± 10.5 cm; mean mass, 75.8 ± 18.4 kg)—completed testing. Quadri.tif strength was evaluated using peak torque during isokinetic knee extension at 90 deg/s and 180 deg/s. Jump distance during the SLHOP and triple hop tests was measured (in cm). Strength and hop test measures were evaluated based on the limb symmetry index ((LSI) = (ACLR / contralateral side) × 100). We operationally defined “pass” as >90% on the LSI. Results: Pass rates were nonuniformly distributed between isokinetic knee extension at 90 deg/s and the SLHOP test ( χ2 = 18.64; P < .001). Disagreements between isokinetic testing at 90 deg/s and the SLHOP test occurred in 36.5% (109/299) of the participants. Among those who failed strength testing and passed hop testing, a greater portion reported higher activity levels before their injury ( χ2 = 6.90; P = .01); however, there was no difference in pass rates between men and women. Similar patterns of disagreement were observed between all strength test and hop test outcomes. Conclusion: ACLR patients with higher activity levels may be more likely to pass hop testing despite failing quadri.tif strength testing. This may be an indicator of movement compensations to achieve jump symmetry in the presence of quadri.tif weakness.

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Does sex affect second ACL injury risk? A systematic review with meta-analysis

Cited by 24 publications

References 86 publications

“I don't opt out of things because I think I will get a sore knee, but I don't expose myself to stupid risks either”: patients’ experiences of a second ACL injury—an interview study

“I don't opt out of things because I think I will get a sore knee, but I don't expose myself to stupid risks either”: patients’ experiences of a second ACL injury—an interview study

Rates and Determinants of Returning to Australian Rules Football in Male Nonprofessional Athletes After Anterior Cruciate Ligament Reconstruction

Disagreement in Pass Rates Between Strength and Performance Tests in Patients Recovering From Anterior Cruciate Ligament Reconstruction

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