Australian Footballers Returning from Anterior Cruciate Ligament Reconstruction Later than 12 Months have Worse Outcomes

Return to Sports: A Risky Business? A Systematic Review with Meta-Analysis of Risk Factors for Graft Rupture Following ACL Reconstruction

BACKGROUND

The risk of sustaining a graft rupture after anterior cruciate ligament reconstruction (ACLR) is high. Contributing risk factors are, however, still not clearly identified.

OBJECTIVE

The aim of this systematic review was to identify and quantify risk factors for graft rupture after ACLR.

METHODS

A systematic review with meta-analysis (PROSPERO CRD42020140129) based on PRISMA guidelines was performed. MEDLINE, CINAHL and EMBASE were searched from inception to September 2021. Prospective and retrospective studies addressing risk factors for graft rupture after ACLR in males/females of all ages were considered. Meta-analyses using a random effect model (effect measure: odds ratio [OR] with 95% confidence interval [CI]) were performed. The GRADE tool was used to assess evidence quality.

RESULTS

Following full-text screening of 310 relevant papers, 117 were eventually included, incorporating up to 133,000 individuals in each meta-analysis. Higher Tegner activity level (≥ 7 vs < 7) at primary injury (OR 3.91, 95% CI 1.69-9.04), increased tibial slope (degrees) (OR 2.21, 95% CI 1.26-3.86), lower psychological readiness to return to sport (RTS) (OR 2.18, 95% CI 1.32-3.61), early surgery (< 12 vs ≥ 12 months) (OR 1.87, 95% CI 1.58-2.22), RTS (pre-injury level) (OR 1.87, 95% CI 1.21-2.91) and family history of ACL injury (OR 1.76, 95% CI 1.34-2.31) were all associated with increased odds of graft rupture. Higher age (OR 0.47, 95% CI 0.39-0.59), female sex (OR 0.88, 95% CI 0.79-0.98), fewer self-reported knee symptoms pre-reconstruction (OR 0.81, 95% CI 0.69-0.95) and concomitant cartilage injuries (OR 0.70, 95% CI 0.62-0.79) instead decreased the odds. Meta-analysis revealed no association between body mass index, smoking, joint laxity, RTS time, knee kinematics, muscle strength or hop performance and graft rupture.

CONCLUSION

Conspicuous risk factors for graft rupture were mainly sports and hereditary related. Few studies investigated function-related modifiable factors or included sports exposure data.

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

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.

To draft or not to draft? A systematic review of North American sports' entry draft

In theory, professional sport "entry drafts" are designed to promote parity by granting poorly performing teams with early selections and winning teams with later selections. While this process has intentions to "level the playing field", mixed findings exist in the literature. The aim of this review is to identify and synthesize the literature examining the efficacy of the draft for professional, North American sport leagues. A systematic review of four databases was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Full-text articles containing relevant data on the draft system for the four major professional North American sports were identified. Further restrictions were made to include articles focusing on a specific outcome regarding future success (i.e., whether the draft related to a measure of future performance). The search returned 10 962 records and after screening, 18 articles were synthesized. Of the articles examined, the measures of future success with relation to draft order were (a) career length and/or number of games played at the majors (n = 8), (b) future performance statistics at the professional level (n = 5), (c) change in winning percentage and/or number of wins produced (n = 3), (d) financial compensation (n = 1), and (e) a combination of measures (a) to (d), (n = 1). Most commonly, the first/early rounds most accurately predicted future measures of success (ie, number of games played, signing bonuses, and playing statistics) across sports. The middle and late rounds were less accurate, with the degree of accuracy increasing slightly in the last rounds. This review highlights several opportunities to better understand the draft process (e.g., potential improvements in middle round picks) and emphasizes the need for more research on analyzing and scrutinizing the draft.

Anterior Cruciate Ligament Injuries in Australian Rules Football: Incidence, Prevention and Return to Play Outcomes

Australian Rules football is the most popular of the various codes of football played in Australia. During the game players perform frequent landing, cutting and pivoting manoeuvres that expose them to substantial risk for anterior cruciate ligament (ACL) injury. Recent years have seen the introduction of a professional women's league that has resulted in an exponential growth in the participation of women and girls in this sport. Unfortunately, there is a corresponding growth in ACL injury rates in female players. This review summarizes the incidence of ACL injury in both men's and women's Australian Rules football and reviews potential causative factors and risk reduction strategies. The final section takes an in depth look at return to sport outcomes after ACL reconstruction surgery in these populations. Whilst an ACL injury does not mean the end of a player's career in Australian football, it certainly presents a significant challenge in terms of return to preinjury levels of form and high rates of secondary and tertiary ACL injury are also a significant concern.