High risk of further ACL injury for players that return to football after ACL reconstruction

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For football players sustaining an anterior cruciate ligament (ACL) rupture reconstructive surgery is often performed to restore knee stability and allow a return to football. This FastFact highlights a ten-year follow up of ACL reconstructed football players and investigates the ability to return to football and risk of further ACL injuries1.

The aim of the study was to follow up on football players ten years after a primary ACL reconstruction to find out how many players returned to football, what influenced their decisions about return to play, and to see whether there are any differences in new ACL injuries between those who returned to play and those who did not. Of the 684 players from the Swedish National Knee Ligament Registry that participated in the study 51% returned to football, 32% to the same or higher level and 18% to a lower level than before the injury. For the 49% that did not return to football 32% did so primarily due to reasons related to the operated knee and the remaining 17% quit primarily for reasons unrelated to the knee injury. The most common knee-related reasons for not returning were pain and/or instability (16%), followed by fear of reinjury (10%). Younger players were more likely to return to football but there was no significant difference between men and women. All the players in the highest division returned to football but return rate dropped with every level of play and at the recreational level only one in four got back to football. The players that returned continued playing for on average five years and 20% were still playing after ten years.

The main finding in this study is that players who return to football have a significantly higher risk of further ACL injury compared to those that did not return to football after ACL reconstruction. Of the players who returned to football, 28.7% (odds ratio [OR] 2.3, p < .001) reported that they had additional ACL injury, 9.7% (OR 2.9, p < .001) had a graft failure and 20.6% (OR 2.1, p < .001) had a contralateral ACL injury. The high risk of sustaining additional ACL injury is of serious concern to the players future knee health and should be considered when deciding on a return to play.

To learn more about the management of ACL injuries complete the Anterior Cruciate Ligament module in the FIFA Diploma in Football Medicine.

Reference
1Sandon A, Engstrom B, Forssblad M. High Risk of Further ACL Injury in a 10-Year Follow-up Study of ACL-Reconstructed Soccer Players in the Swedish National Knee Ligament Registry. Arthroscopy. 2019. Epub 2019/08/24. doi: 10.1016/j.arthro.2019.05.052.

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Camilo Andrés Villamizar Sierra
17 October 2019 22:27

¿cual seria una propuesta real desde la prevención para que el jugador disminuya el riesgo de relesión del LCA?

Antonio Maestro
Antonio Maestro
19 October 2019 10:39

So, the most important thing could be te time for returning? have we wait more time for returning?
It’s really graft depending (thinking on a correct technique) or only sport depending?. In these case football but only for football players or more sports?.
Thank you

Dr Shahram Mohaghegh
29 April 2020 8:07

Dear Antonio, , The most important is good rehabilitation before return to sport . Gradual return to feild is very important too.

ALIREZA KESHMIRI
25 October 2019 11:02

👍👍👍

ALIREZA KESHMIRI
25 October 2019 11:03

thankyou

Bangoura
Bangoura
24 November 2019 14:13

CHEZ LES JOUEURE DE FOOTBALL UNE D3S LESIONS LES PLUS GRAVES EST LA LESION DU LIGAMENT CROISE ANTERIEUR.LA BLESSURE NECESSITE UNE BONNE PRISE EN CHARGE ET DES EXAMENS D IMAGERIE TRES POUSSE UNE CHIRURGIE DE RECONSTRUCTION D INTENSE SEANCEDE KINESITHERAPIE ET DE REEDUCATION AINSI QU UNE SURVEILLANCE CONTINUE POUR DIMINUER LES RISQUEES DE NOUVELLE BLESSURE.LES JOUEURS SOUFFRANT D UNE DECHIRURE DU LCA SONT HABITUELLEMENT DANS L INCAPACITE DE JOUER AU FOOTBALL PENDANT ENVIRONS 1AN.IL SONT ENSUITE PLUS PREDISPOSES A DEVELOPPER UNE ARTHOSE POST TRAUMATIQUE. EN RAISON DE LA GRAVITE DE LA LESION LA PREVENTION DOIT PREVALOIR LES FACTEURS DE RISQUE… Read more »

Bangoura
Bangoura
24 November 2019 19:19

LIRE PREDISPOSER A DEVELOPPER UNE ARTHROSE POST TRAUMATIQUE