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Pinheiro VH, Borque KA, Laughlin MS, Jones M, Balendra G, Kent MR, Ajgaonkar R, Williams A. Determinants of Performance in Professional Soccer Players at 2 and 5 Years After ACL Reconstruction. Am J Sports Med 2023; 51:3649-3657. [PMID: 37960868 DOI: 10.1177/03635465231207832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND A number of studies have investigated return to play after anterior cruciate ligament reconstruction (ACLR) in professional soccer players, but it is unclear which factors are associated with a return to the preinjury performance and ability to play over time. PURPOSE To identify factors that contribute to a professional soccer player's return to preinjury performance after ACLR, as well as to report their playing performance at 2 and 5 years after ACLR compared with their preinjury performance. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A consecutive cohort of professional soccer players undergoing primary ACLR were analyzed between 2005 and 2019. A minimum 2-year follow-up was required. The effect of patient, surgical, and postoperative factors on performance rates, defined as a combination of league level and playing time, was evaluated with univariate and multivariate logistic regression models. RESULTS A total of 200 male professional soccer players were included. When combining league level and playing time, 30% of athletes returned to their preinjury performance at 2 years and 22% at 5 years. However, 53% of athletes returned to their preinjury performance for at least 1 season by year 5. At 2 years, a chondral lesion of grade 3 or 4 decreased the odds of return to preinjury performance (odds ratio [OR], 0.37; P = .010). Athletes receiving an ACLR with the addition of a lateral extra-articular tenodesis procedure were 2.42 times more likely to return to preinjury performance at 2 years than athletes with ACLR alone (P = .004). By 5 years after ACLR, athletes aged ≥25 years at the time of reconstruction were 3 times less likely to be performing at their preinjury performance (OR, 0.32; P < .001), and those with a grade ≥3 chondral lesion were >2 times less likely to be performing at their preinjury performance (OR, 0.43; P = .033). CONCLUSION The presence of >50% thickness chondral pathology, ACLR without lateral extra-articular tenodesis, and age >25 years at the time of surgery were all significant risk factors of worse performance rates after ACLR. Significant decreases in performance rates were noted at 2 and 5 years postoperatively.
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Affiliation(s)
| | - Kyle A Borque
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Mitzi S Laughlin
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Mary Jones
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, United Kingdom
| | - Ganesh Balendra
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, United Kingdom
| | | | - Ryan Ajgaonkar
- University of Texas Rio Grande Valley Medical School, Edinburg, Texas, USA
| | - Andy Williams
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, United Kingdom
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Thorolfsson B, Svantesson E, Snaebjornsson T, Sansone M, Karlsson J, Samuelsson K, Senorski EH. Adolescents Have Twice the Revision Rate of Young Adults After ACL Reconstruction With Hamstring Tendon Autograft: A Study From the Swedish National Knee Ligament Registry. Orthop J Sports Med 2021; 9:23259671211038893. [PMID: 34660824 PMCID: PMC8516395 DOI: 10.1177/23259671211038893] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/25/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Previous studies have identified young age as a risk factor for anterior cruciate ligament (ACL) revision. However, few studies have looked separately at pediatric patients and adolescents with regard to outcomes after ACL reconstruction. Purpose: To determine whether patient age at ACL reconstruction affects the risk of undergoing revision surgery in young patients. Study Design: Cohort study; Level of evidence, 3. Methods: This study was based on data from the Swedish National Knee Ligament Registry. Patients aged 5 to 35 years who underwent a primary ACL reconstruction with a hamstring tendon autograft between January 1, 2005, and December 31, 2015, were included. The cohort was stratified into different age groups of pediatric patients, adolescents, and young adults to estimate patients with open, recently closed, and closed epiphyses, respectively. The primary endpoint was ACL revision. A multivariable Cox regression model was used to assess the ACL revision rate. The results were expressed as hazard ratios (HRs) and 95% CIs. Results: A total of 36,274 ACL reconstructions were registered during the study period. Of these, 2848 patients were included in the study: 47 pediatric patients (mean age, 13.6 years; range, 9-15 years), 522 adolescents (mean age, 17.4; range, 14-19 years), and 2279 young adults (mean age, 27.0; range, 20-35 years). A total of 31 patients (1.1%) underwent ACL revision within 2 years (0 pediatric patients, 9 adolescents [1.7%], and 22 young adults [1.0%]) and a total of 53 patients (2.6%) underwent ACL revision within 5 years (2 pediatric patients [6.9%], 15 adolescents [3.9%], and 36 young adults [2.2%]). The adolescent age group had a 1.91 times higher rate of ACL revision compared with the young adults (HR = 1.91 [95% CI, 1.13-3.21]; P = .015). There were no differences in revision rates between the pediatric age group and the young adults (HR = 2.93 [95% CI, 0.88-9.79]; P = .081). Conclusion: Adolescents had almost twice the rate of revision ACL reconstruction compared with young adults.
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Affiliation(s)
- Baldur Thorolfsson
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Sports Trauma Research Center, Gothenburg, Sweden
| | - Eleonor Svantesson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Sports Trauma Research Center, Gothenburg, Sweden
| | - Thorkell Snaebjornsson
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Sports Trauma Research Center, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Sports Trauma Research Center, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Sports Trauma Research Center, Gothenburg, Sweden
| | - Kristian Samuelsson
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Sports Trauma Research Center, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Gothenburg Sports Trauma Research Center, Gothenburg, Sweden.,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sportrehab Sports Medicine Clinic, Gothenburg, Sweden
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Webster KE, Hewett TE, Feller JA. Anterior Cruciate Ligament Injuries in Australian Rules Football: Incidence, Prevention and Return to Play Outcomes. Open Access J Sports Med 2021; 12:33-41. [PMID: 33833597 PMCID: PMC8020809 DOI: 10.2147/oajsm.s250414] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/12/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Timothy E Hewett
- Hewett Global Consulting, Rochester MN & Rocky Mountain Consortium for Sports Research, Edwards, CO, USA
| | - Julian A Feller
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia.,OrthoSport Victoria, Epworth HealthCare, Melbourne, VIC, Australia
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