Two-thirds of athletes who have had reconstructive surgery to repair an anterior cruciate ligament (ACL) tear have not returned to competitive sports 12 months after surgery, according to a new Australian study reported in the American Journal of Sports Medicine.1 The findings are in sharp contrast to earlier studies showing a much higher rate of return to sports at the 1-year mark post-surgery.
As many parents know, anterior cruciate ligament (ACL) injuries are increasingly common [1] among youth athletes, particularly girls [2], playing sports - such as soccer [3], basketball, football, and lacrosse - that involve a lot of cutting, jumping and pivoting.
Reconstructive surgery of the ACL [4], followed by an extensive rehabilitation program emphasizing early weightbearing and the immediate commencement of exercises to restore knee range of motion and muscle strength, can allow athletes to return to sport after medical clearance between 6 to 12 months postoperatively, with most targeting a return to sports within 12 months after surgery.
But, while athletes are typically advised that they will require a break from sport of approximately 6 to 12 months for full recovery of knee function after ACL injury and surgery, the study suggests that, if a successful return to sport is defined as a return to the preinjury sports participation level, many athletes will require a longer period of postoperative rehabilitation to ensure a successful return to sport than previously thought.
"The bottom line is that the knee is not normal, even 12 months after surgery," says Dr. Darren Johnson, Professor and Chairman of the Department of Orthopaedic Surgery and Director of Sports Medicine at the University of Kentucky School of Medicine. "When the knee is ready [for a return to sports] is extremely variable between patients. The pressure [on kids] to return to early in sports from all parties - kid, parent, coaches, friends, and society in general - is very high. Kids need to hold back until the knee is ready."
Researchers at La Trobe (Aus.) University's Musculoskeletal Research Centre studied athletes who had participated in competitive level Australian football, basketball, soccer and netball (a sport similar to basketball played by Australian women) before their ACL injury and who then had arthroscopic ACL reconstructive surgery performed by the same surgeon between May 2003 and December 2008.
The study participants had all followed the same rehabilitation program after surgery (weightbearing the first postoperative day, quadriceps strengthening during the first 3 months postoperatively, straight-line running beginning at 12 weeks, progressing to sport-specific drills at 16 weeks), and then been cleared by the surgeon to return to sports based on completion of the full rehabilitation program, full knee range of motion, a stable knee, functional quadriceps control, and no fluid in the knee.
When the athletes returned at 12 months:
Twelve months after ACL reconstruction surgery:
Earlier studies suggested a link between psychological factors and return to sport [5] after ACL reconstruction. Two showed that patients up to 4 years post-ACL reconstruction surgery reported a fear of reinjury, with patients exhibiting a higher fear of reinjury less likely to have returned to their preinjury level of sports participation when compared with patients with a lower fear of reinjury. A third study showed that athletes who had returned to their preinjury level of sports participation level at 12 months after ACL reconstruction surgery scored significantly higher on a test assessing confidence, emotions and risk appraisal.
Based on these studies and their new findings, the authors suggested that further investigation of psychological functioning after ACL reconstruction surgery may be warranted.
The return-to-sport rate reported in the study was sharply lower than in previous studies, which reported a return-to-sport rate of 75% and a return to competitive sport rate of 64%. The study's authors suggested that the lower rate may be explained by the fact that return to sport in their study was to the pre-injury level of competition, while earlier studies did not specify whether participants returned to either their pre-injury level of competition, or even to their preinjury sport and thus may have overestimated the return-to-competitive sport rate.
"Surgery is the easy part," says Dr. Johnson. "[It is the] rehabilitation that is the hard part. It is a mentally and physically a challenge for young athletes who, for the most part, have never had to go anything like it."
Created November 29, 2010
Links:
[1] https://www.momsteam.com/node/2491
[2] https://www.momsteam.com/node/803
[3] https://www.momsteam.com/node/2481
[4] https://www.momsteam.com/node/1401
[5] https://www.momsteam.com/node/2581
[6] https://www.momsteam.com/health-safety/sports-injuries-youth-sports-parents-need-to-hear-the-truth
[7] https://www.momsteam.com/health-safety/acl-reconstructive-surgery-return-to-play-not-guaranteed
[8] https://www.momsteam.com/health-safety/muscles-joints-bones/knee/acl-injuries-in-female-athletes
[9] https://www.momsteam.com/health-safety/acl-reconstruction-using-cadaver-replacement-ligaments-not-best-choice-for-younger-athletes
[10] https://www.momsteam.com/health-safety/delay-in-ACL-surgery-increases-risk-of-permanent-injury-early-surgery-recommended