One anterior cruciate ligament reconstruction (ACLR) often leads to another, according to a study presented at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Annual Meeting and reported in Science Daily. The study revealed that the chance of having to go through the surgery again within 24 months is six times greater than it is for someone who had never had an ACL tear.
One ACLR Tear Leads to Another
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The study also found that female athletes, after experiencing an ACLR demonstrated a more than four times greater rate of injury within 24 months than did 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, Ph.D., from the Cincinnati Children’s Hospital.
Researchers analyzed data from 78 subjects, 59 were female and 19 were male. All were between 10 and 25 years old, all had undergone ACLR and all were ready to return to a pivoting/cutting sport. There were also 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 four of the control subjects suffered an ACL injury.
Within the ACLR group, there 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. 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 two-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.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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