Epidemiology of Recurrent Anterior Cruciate Ligament Injuries in National Collegiate Athletic Association Sports: The Injury Surveillance Program, 2004-2014

Gans, Itai; Retzky, Julia; Jones, Lynne C.; Tanaka, Miho J.

doi:10.1177/2325967118777823

Cited by 110 publications

(85 citation statements)

References 45 publications

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“…15,18,19 Additionally, they have a 3.8times higher retear rate than do men after undergoing reconstruction and almost a 5-fold higher rate of subsequent ACL injury as compared with female soccer player controls with no previous knee injury. 7,8,11 There is also a 28% rate of ACL retear after ACLR and a 34% rate of retear after returning to soccer. 2 Aside from associated risks with sex and sport participation, our population is at higher risk for reinjury given its young age and the known association with higher reinjury.…”

Section: Discussionmentioning

confidence: 99%

The Challenges of Treating Female Soccer Players With ACL Injuries: Hamstring Versus Bone–Patellar Tendon–Bone Autograft

Britt

Ouillette

Edmonds

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Although anterior cruciate ligament (ACL) injuries are common in female soccer players, the optimal graft option for ACL reconstruction is currently unclear. Purpose/Hypothesis: To compare the outcomes of female soccer players after ACL reconstruction using either hamstring tendon autograft or bone–patellar tendon–bone (BTB) autograft. We hypothesized that there would be no difference in clinical outcome scores, return to sport, or retear rates between BTB and hamstring grafts in our study cohort. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective review of all skeletally mature adolescent female soccer players who underwent primary ACL reconstruction using either hamstring tendon or BTB autograft between 2013 and 2016. Demographic, injury, and surgical variables were documented. Outcome measures included the Lysholm score, Single Assessment Numeric Evaluation, Tegner activity score, and visual analog scales for pain and for satisfaction, as well as ability to return to sport. Results: Overall, 90 female soccer players met the inclusion criteria, of whom 79% (41 BTB and 30 hamstring) were available for a minimum 2-year follow-up or had a graft failure before the follow-up. The BTB group had a lower body mass index (mean ± SD, 23 ± 3 vs 25 ± 4; P = .02) and shorter postoperative follow-up time in months (mean ± SD, 37.4 vs 46.1; P ≤ .001); otherwise, no differences in demographic, injury, or surgical variables between groups were noted. Regarding outcome measures, the BTB group achieved a higher Tegner score (6.0 vs 4.2; P = .004), and there was no other difference between groups. Of the patients who did not return to soccer, 44.7% reported fear as the reason. Of the patients who did return to soccer, 31.9% sustained another ACL injury (retear or contralateral tear), with no differences in reinjury rates based on graft selection. Conclusion: Adolescent female soccer players undergoing ACL reconstruction had relatively high satisfaction and outcome scores independent of autograft choice. Notwithstanding, patients and families need to be counseled that less than half of patients will return to their preinjury level of sport and, if an athlete attempts to return, there is a high risk of further ACL injury.

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Section: Discussionmentioning

confidence: 99%

The Challenges of Treating Female Soccer Players With ACL Injuries: Hamstring Versus Bone–Patellar Tendon–Bone Autograft

Britt

Ouillette

Edmonds

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Additionally, age was constrained to include only those aged 13 to 24 years at enrollment (ACL-SPORTS) or time of surgery (Delaware Oslo and MOON) to focus on the young female athletes at particularly high risk for poor outcomes after ACLR. 4,10,16,21,25,38–40,46 Inclusion criteria were female sex; age 13 to 24 years at enrollment; available functional outcomes data from approximately 2 years after primary, unilateral ACLR; and participant in level 1 or 2 sport 15,24 prior to index ACLR. Exclusion criteria were previous ACL injury to either knee; symptomatic concomitant grade 3 knee ligament (ie, posterior cruciate ligament [PCL], lateral collateral ligament [LCL], medial collateral ligament [MCL] injury or surgery; articular cartilage defect larger than 1 cm 2 or microfracture surgery; or second ACL rupture (Delaware-Oslo) or ACLR (ACL-SPORTS and MOON) to either knee prior to 2-year testing.…”

Section: Methodsmentioning

confidence: 99%

Superior 2-Year Functional Outcomes Among Young Female Athletes After ACL Reconstruction in 10 Return-to-Sport Training Sessions: Comparison of ACL-SPORTS Randomized Controlled Trial With Delaware-Oslo and MOON Cohorts

Capin

Failla

Zarzycki

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Outcomes after anterior cruciate ligament reconstruction (ACLR) are not uniformly good and are worse among young female athletes. Developing better rehabilitation and return-to-sport training programs and evaluating their outcomes are essential. Purpose: (1) Test the effect of strength, agility, plyometric, and secondary prevention (SAPP) exercises with and without perturbation training (SAPP + PERT) on strength, hops, function, activity levels, and return-to-sport rates in young female athletes 1 and 2 years after ACLR and (2) compare 2-year functional outcomes and activity levels among young female athletes in the Anterior Cruciate Ligament Specialized Post-Operative Return-to-Sports (ACL-SPORTS) trial to homogeneous cohorts who completed criterion-based postoperative rehabilitation alone (Multicenter Orthopaedic Outcomes Network [MOON]) and in combination with extended preoperative rehabilitation (Delaware-Oslo). Study Design: Randomized controlled trial, Level of evidence, 1; and cohort study, Level of evidence, 3. Methods: A total of 40 level 1 and level 2 female athletes were enrolled after postoperative impairment resolution 3 to 9 months after primary ACLR. Participants were randomized to 10 SAPP or SAPP + PERT sessions and were tested 1 and 2 years after ACLR on quadriceps strength, hop tests, functional outcomes, and return-to-sport rates. Participants were then compared with homogeneous cohorts of young (<25 years) female athletes who completed criterion-based postoperative rehabilitation alone (MOON) and in combination with extended preoperative rehabilitation (Delaware-Oslo) on 2-year functional outcomes. Results: No significant or meaningful differences were found between SAPP and SAPP + PERT, so groups were collapsed for comparison with the other cohorts. At 2-year follow-up, ACL-SPORTS had the highest scores ( P < .01) on the Marx activity rating scale (ACL-SPORTS, 13.5 ± 3.3; Delaware-Oslo, 12.5 ± 2.7; MOON, 10.6 ± 5.1); International Knee Documentation Committee Subjective Knee Evaluation Form (96 ± 7, 92 ± 9, and 84 ± 14, respectively); and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales for Pain (98 ± 4, 94 ± 9, and 90 ± 10, respectively), Symptoms (94 ± 6, 90 ± 9, and 83 ± 14, respectively), Activities of Daily Living (100 ± 1, 99 ± 4, and 96 ± 7, respectively), Sports and Recreation (94 ± 8, 86 ± 15, and 82 ± 17, respectively), and Quality of Life (89 ± 14, 78 ± 18, and 76 ± 19, respectively). The Patient Acceptable Symptom State threshold on the KOOS–Sports and Recreation was achieved by 100% of the ACL-SPORTS cohort compared with 90% of Delaware-Oslo and 78% of MOON ( P = .011). Conclusion: Although perturbation training provided no added benefit, 10 sessions of return-to-sport training, compared with criterion-based postoperative rehabilitation alone, yielded statistically significant and clinically meaningfully higher 2-year functional outcomes among young, high-level female athletes after ACLR. Registration: NCT01773317 ( ClinicalTrials.gov identifier).

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“…Ruptures of the anterior cruciate ligament (ACL) occur with an incidence of 80 per 100,000 individuals each year [ 1 ]. ACL rupture causes knee instability, deficiencies in motor control and impaired arthrokinematics [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Relationship between pre- and post-operative isokinetic strength after ACL reconstruction using hamstring autograft

Riesterer¹,

Mauch²,

Paul³

et al. 2020

BMC Sports Sci Med Rehabil

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Background Anterior cruciate ligament (ACL) ruptures are of major concern in sports. As mostly young and active individuals are affected there is an emphasis on the rapid and safe return to sports (RTS). Strengthening the ventral and dorsal thigh muscles is a prerequisite for a successful RTS after ACL reconstruction (ACLR), as persistent muscle weakness may increase the incidence for secondary injuries and impair performance. Aiming to increase evidence on the importance of preoperative muscle strength and the coaching of patients, the purpose of this study is to compare thigh muscle strength pre- and post-operatively after ACLR. Methods We performed a retrospective analysis of 80 patients with primary, isolated ACLR using a four-stranded hamstring autograft. We performed bilateral isokinetic concentric strength measurement (60°/s) before and six months after ACLR. Primary outcomes were the maximal knee extension and flexion torque, hamstrings-to-quadriceps ratio (H/Q ratio) and the corresponding limb symmetry indices (LSI). Pearson correlations were calculated for pre- and post-surgical values. Results The operated as well as the unaffected leg increased maximal knee extension (+ 18% ± 7% p < 0.05; + 11% ± 5% p < 0.05) and flexion torque (+ 9% ± 5% p < 0.05, + 10% ± 6% p < 0.05) throughout the 6 months of rehabilitation. The H/Q ratio remained unaffected (− 2% ± 3% p = 0.93; − 4% ± 4% p = 0.27). LSI of knee extension strength increased significantly (6% ± 3% p < 0.05), while flexion strength remained unaffected (+ 2% ± 4% p = 0.27). Positive correlations underline the interrelationship between the strength pre- and post-surgery for the knee extension (r = 0.788 p < 0.05) and knee flexion strength (r = 0.637 p < 0.05) after ACLR. Conclusions Preoperative leg extension and flexion strength normalized to body mass are strongly correlated to postoperative strength performance after ACLR. Therefore, pre-operative quadriceps and hamstring muscle strength deficits may have a significant negative impact on functional performance following ACLR. This emphasizes the need for intensive preoperative screening and subsequent treatment to achieve the best possible preoperative leg strength before ACLR. Trial registration DRKS00020210.

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Epidemiology of Recurrent Anterior Cruciate Ligament Injuries in National Collegiate Athletic Association Sports: The Injury Surveillance Program, 2004-2014

Cited by 110 publications

References 45 publications

The Challenges of Treating Female Soccer Players With ACL Injuries: Hamstring Versus Bone–Patellar Tendon–Bone Autograft

The Challenges of Treating Female Soccer Players With ACL Injuries: Hamstring Versus Bone–Patellar Tendon–Bone Autograft

Superior 2-Year Functional Outcomes Among Young Female Athletes After ACL Reconstruction in 10 Return-to-Sport Training Sessions: Comparison of ACL-SPORTS Randomized Controlled Trial With Delaware-Oslo and MOON Cohorts

Relationship between pre- and post-operative isokinetic strength after ACL reconstruction using hamstring autograft

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