ACL Injuries 6X More Likely After Surgery

ACL Injuries 6X More Likely After Surgery

While Anterior cruciate ligament reconstruction (ACLR) surgery is a common knee injury procedure, but the overall incidence rate of having to go through it again within 24 months is 6 times greater than someone who has never had an ACL tear, according to researchers presenting their work today at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Annual Meeting in Chicago, IL.

“In our study, female athletes after ACLR demonstrated more than four times greater rate of injury within 24 months than their healthy counterparts. This data highlights the fact that ACLR patients who return to playing sports are at greater risk for injury and should take appropriate precautions to prevent injury,” said lead author, Mark V. Paterno, PhD, PT, SCS, ATC from the Cincinnati Children’s Hospital.

Researchers analyzed data from 78 subjects (59 female, 19 male) between 10 and 25 years old, who underwent ACLR and were ready to return to a pivoting/cutting sport (RTS) and 47 healthy, control individuals. Each subject was followed for injury and athletic exposure for a 24-month period after returning to play. Twenty-three of the ACLR individuals and 4 control subjects suffered an ACL injury. Within the ACLR group, there also appeared to be a trend for female subjects to be two times more likely to suffer an injury on the opposite knee than on the previously injured one.

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Overall, 29.5% of athletes suffered a second ACL injury within 24 months of returning to activity with 20.5% sustaining an opposite leg injury and 9.0% incurring graft re-tear injury on the same leg. A higher proportion of females (23.7%) suffered an opposite leg injury compared to males (10.5%).

“Our study represents the first report of subsequent ACL injury incidence rate focused on 2 -year outcomes of young, active patients returning to sport. Even though additional research still needs to be performed to support our findings, our data does provide early evidence for re-examining current rehabilitation and return to sport protocols following ACLR,” said Paterno.

"This is sobering data indeed," said Robert Shalvoy, MD, an orthopedic surgeon with the Total Joint Center at The Miriam Hospital. "We knew from the same study cohort reported at one year and from several other studies that reinjury and retears of reconstructed ACLs were much higher than we thought or wanted to believe," he said.

The faux slam-dunk

The public has a mindset, reinforced by sources like ESPN, said Shalvoy, "that an ACLreconstruction is a slam-dunk procedure and success is a near guarantee. This has led to people wanting to come back sooner and more aggressively than ever before with expectations to be as good if not better than ever." Shalvoy said this is compounded by certain sports like youth soccer where there is a competitive season year round "that drives patients to jump back into competition as soon as possible and not when they are ready. There just isn't any evidence to support this approach," he said.

According to Shalvoy, three basic elements that contribute to the current state of reinjury after ACLR. "First, the surgery has to be done more precisely and more individualized to the patient's injury and needs," he said. "Our own work at the Miriam with computer navigation has given us much needed feedback to this end which is currently being analyzed and published. There are different patterns of injury and different needs to be met surgically that are not being met with a singular approach toACL reconstruction. This leads to increased failures."

Secondly, he said, the ACL graft has to heal in the post operative period or it will be weak and incapable of withstanding the stress of athletics. "Patients must work with their surgeon and a qualified therapist to create a nurturing environment for the graft with the appropriate support and stimulation to improve the amount and quality of healing," he said.

Third, the amount of time needed to restore the strength, stamina, balance and athleticism of the injured athlete after ACLreconstruction is longer than most athletes perceive. "Most reinjured athletes are injured early after their return from surgery, especially before the six to nine month recovery period," Shalvoy said.

Overall, "It is important that patients understand the reality of ACL injury, ACL reconstruction and returning to sports to improve their outcomes." And attempt to better their game against the odds of reinjury.