How to get a better picture of the ACL injury problem? A call to systematically include conservatively managed patients in ACL registries

High Incidence of Anterior Cruciate Ligament Injuries Within the First 2 Months of the Season in Amateur Team Ball Sports

BACKGROUND

The incidence of anterior cruciate ligament (ACL) injuries is commonly reported as an annual incidence rate. There is relatively little information about the seasonal aspects of these injuries. The aim of the current study was to analyze the distribution of ACL injuries during the season in nonprofessional soccer, handball, and basketball based on a retrospective analysis of a hospital-based registry.

HYPOTHESIS

ACL injuries in soccer, handball, and basketball were more common within the first 2 months of the season in comparison with the rest of the year.

STUDY DESIGN

Case series.

LEVEL OF EVIDENCE

Level 4.

METHODS

Injury occurrence during the calendar year was divided into 6 periods of 2 months, with segment 1 (S1) representing the first 2 months of the season. For soccer, S1 corresponded to September and October. The season started 1 month later for handball and basketball, so S1 represented October and November. Chi-square tests were used to analyze the distribution of ACL injuries among segments according to gender, age, sports, and injury mechanism (contact/noncontact).

RESULTS

A total of 371 ACL injuries were included (soccer, 258, handball, 56, basketball, 57). Overall, the distribution of ACL injuries was not uniform across the segments (P < 0.01). Almost one-third of the ACL injuries occurred in S1 (n = 104; 28%). Significant differences could be observed according to sports (P < 0.01). There were fewer ACL injuries in S2 for soccer compared with basketball (P < 0.05). In S5, there were significantly more ACL injuries in soccer compared with handball and basketball (P < 0.05).

CONCLUSION

A high occurrence of ACL injuries was reported immediately within the first 2 months of the season in nonprofessional soccer, handball, and basketball sports.

CLINICAL RELEVANCE

These findings indicate that ACL injury prevention programs should be started in the preseason period to allow for gradual increases of load.

Injury incidence and burden in a youth elite football academy: a four-season prospective study of 551 players aged from under 9 to under 19 years

OBJECTIVE

Investigate the incidence and burden of injuries by age group in youth football (soccer) academy players during four consecutive seasons.

METHODS

All injuries that caused time-loss or required medical attention (as per consensus definitions) were prospectively recorded in 551 youth football players from under 9 years to under 19 years. Injury incidence (II) and burden (IB) were calculated as number of injuries per squad season (s-s), as well as for type, location and age groups.

RESULTS

A total of 2204 injuries were recorded. 40% (n=882) required medical attention and 60% (n=1322) caused time-loss. The total time-loss was 25 034 days. A squad of 25 players sustained an average of 30 time-loss injuries (TLI) per s-s with an IB of 574 days lost per s-s. Compared with the other age groups, U-16 players had the highest TLI incidence per s-s (95% CI lower-upper): II= 59 (52 to 67); IB=992 days; (963 to 1022) and U-18 players had the greatest burden per s-s: II= 42.1 (36.1 to 49.1); IB= 1408 days (1373 to 1444). Across the cohort of players, contusions (II=7.7/s-s), sprains (II=4.9/s-s) and growth-related injuries (II=4.3/s-s) were the most common TLI. Meniscus/cartilage injuries had the greatest injury severity (95% CI lower-upper): II= 0.4 (0.3 to 0.7), IB= 73 days (22 to 181). The burden (95% CI lower-upper) of physeal fractures (II= 0.8; 0.6 to 1.2; IB= 58 days; 33 to 78) was double than non-physeal fractures.

SUMMARY

At this youth football academy, each squad of 25 players averaged 30 injuries per season which resulted in 574 days lost. The highest incidence of TLI occurred in under-16 players, while the highest IB occurred in under-18 players.

Clinical course and recommendations for patients after anterior cruciate ligament injury and subsequent reconstruction: A narrative review

Almost all athletes who have suffered an anterior cruciate ligament (ACL) injury expect a full return to sports at the same pre-injury level after ACL reconstruction (ACLR). Detailed patient information on the reasonable outcomes of the surgery may be essential to improve patient satisfaction.

Pre-operative rehabilitation before ACLR should be considered as an addition to the standard of care to maximise functional outcomes after ACLR.

We propose an optimised criterion-based rehabilitation programme within a biopsychosocial framework.

No benchmark exists for evaluating return-to-sport (RTS) readiness after ACLR. Therefore, the authors propose a multi-factorial RTS test battery. A combination of both physical and psychological elements should be included in the RTS test battery.

There is need for shared decision-making regarding RTS.

Cite this article: EFORT Open Rev 2017;2:410-420. DOI: 10.1302/2058-5241.2.170011