This prospective study compared female players who underwent an ACL reconstruction (ACLR) with their healthy peers. The authors found that the players who had an ACLR were both more likely to re-injure their knee and to quit playing football1.
Anterior cruciate ligament (ACL) injuries are a common problem in football players with female players having a substantially greater risk of injury than men. While ACLR can achieve good knee function and there are high levels of return to sport amongst elite players, this is less likely to be the case in recreational players. Compared with elite players, recreational players are less likely to return to sport. In both elite and non-elite players there are relatively high rates of post-traumatic osteoarthritis and future morbidity.
This FastFact highlights a prospective cohort study from the American Journal of Sports Medicine. A total of 117 female football players who had an ACLR (almost all using hamstring autograft) were compared to 119 players who had healthy knees and played in the same football teams. These players were followed for two years looking at new knee injuries, other injuries, football playing level, activity level (on the Tegner Activity Scale), and satisfaction with activity level and knee function.
The results of this study are in line with other data, reporting an increased risk of sustaining a new ACL injury after an ACLR. In this series, players with a history of ACLR were five-times more likely to sustain a further ACL injury. There was also a two- to four-fold higher rate of other traumatic and non-traumatic knee injuries compared with controls. Finally players with a history of ACLR were more likely to stop playing football than those who had not sustained an injury.
The data presented in this series, and in other similar studies, clearly illustrates an increased risk of further knee injury following a primary ACL injury. This study also shows that this is associated with lower participation rates. The importance of ACL prevention programmes, which can reduce the risk of injury by about 50%, is clearly illustrated. This type of programme can reduce the risk of the primary injury, reduce the risk of subsequent injury and can prevent substantial morbidity.
1Fältström A, Kvist J, Gauffin H, Hägglund M. Female Soccer Players With Anterior Cruciate Ligament Reconstruction Have a Higher Risk of New Knee Injuries and Quit Soccer to a Higher Degree Than Knee-Healthy Controls. Am J Sports Med. 2019 Jan; 47(1):31-40.