It is well known that injuring the Anterior Cruciate Ligament (ACL) is associated with increased rates of post-traumatic osteoarthritis (OA). It is often felt that the act of returning to sport may make this more likely. This recent article from the BJSM suggests that returning to ‘pivoting sport’ may actually be desirable1.
This study involved a secondary analysis of data that had been prospectively collected on 258 patients who had been treated with an ACL reconstruction between 1990 and 1997. The majority of these patients were treated with patella tendon autografts with a smaller number receiving hamstrings autografts. Symptomatic OA was defined as Kellgren and Lawrence grade ≥2 plus almost daily knee pain in the last month. Self-reported symptoms, function and quality of life were also assessed via the Knee Injury and Osteoarthritis Outcome Score (KOOS). Data relating to the patient’s ability to return to pivoting sport (the majority of the participants played football) was collected retrospectively.
210 participants (57% men) with a mean age of 39.1 years completed 15-year follow-up. Of these 109 (52%) had returned to pivoting sport. Participants that had been able to return to play had less symptomatic and radiographic OA (adjusted for age, sex, combined injury, self-reported knee function, and time between injury and surgery). Those who returned to pivoting sport also reported better knee function. While this reached statistical significance the absolute difference in KOOS was small and potentially not clinically relevant.
Based on this data participants who returned to pivoting sport were less likely to have symptomatic OA and were more likely to report good knee function. While there are a number of methodological considerations, I think that this study does have the potential to impact clinical practice. Specifically it does not appear that there was a major increased risk of OA for those players who did return to football. This is a relevant finding as it will help clinicians council those who wish to return to play following an ACL reconstruction.
1.Øiestad BE, Holm I, Risberg MA Return to pivoting sport after ACL reconstruction: association with osteoarthritis and knee function at the 15-year follow-up Br J Sports Med 2018;52:1199-1204.