A retrospective analysis of return to sports after 9 months in athletes in cases of anterior cruciate ligament reconstruction

  • Butala R P Department of Orthopaedics, D. Y. Patil Hospital and research centre, Nerul, Navi Mumbai, Maharashtra
  • Parelkar K Department of Orthopaedics, D. Y. Patil Hospital and research centre, Nerul, Navi Mumbai, Maharashtra
  • Syal A D Department of Orthopaedics, D. Y. Patil Hospital and research centre, Nerul, Navi Mumbai, Maharashtra
  • Chandiramani V Department of Orthopaedics, D. Y. Patil Hospital and research centre, Nerul, Navi Mumbai, Maharashtra
Keywords: Anterior cruciate ligament reconstruction, return to sport activity

Abstract

Background: The anterior cruciate ligament (ACL) is responsible for maintaining stability of the knee joint, particularly in activities involving pivoting or kicking. The knee loses its stability if the ACL is ruptured and the joint may become more damaged over time. ACL reconstruction is the surgical treatment of choice. Aim of this study is to analyze the rate of return to sports after 9 months in cases of anterior cruciate ligament reconstruction.

Material & Methods: All cases operated for ACL reconstruction between the year 2017- 2020 were studied .This group included 80 patients with traumatic twisting, pivoting injury while playing sports, diagnosed with ACl tear, with instability at the knee joint .Exclusion criteria included avulsion injuries, meniscus involvement, posterior collateral ligament involvement, collateral involvement and any fracture of either femur or tibia involvement. The Scoring system used is ACL RSI (anterior cruciate ligament return to sport and injury scale).

Results: Total eighty athletes were included in this study. There was no association of symmetrical muscle function or quadriceps strength .The patients with a lower ACL RSI (anterior cruciate ligament –return to sport and injury scale) score had a lower rate of return to sports after 9 months post ACL reconstruction as well as a higher rate of secondary ACL injury.

Conclusion: Athletes operated for ACL reconstruction showed a low rate of return to their sports after 9 months. One of the potential concerns was with returning to sports the re-injury rate to the reconstructed ACL or to the other structures (cartilage, menisci or other ligaments) (1-3). Approximately 1 in 4 patients who are 25 years of age or younger and return to high-risk sport after primary anterior cruciate ligament (ACL) reconstruction sustain a second ACL injury (4).

Downloads

Download data is not yet available.

References

Sandberg R, Balkfors B. Reconstruction of the anterior cruciate ligament. A 5-year follow-up of 89 patients. Acta Orthop Scand 1988;59:288–93

Otto D, Pinczewski LA, Clingeleffer A, et al. Fiveyear results of single-incision arthroscopic anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 1998;26:181–8

Bak K, Scavenius M, Hansen S, et al. Isolated partial rupture of the anterior cruciate ligament. Long-term follow-up of 56 cases. Knee Surg Sports Traumatol Arthrosc 1997;5:66–71

Wiggins AJ, , Grandhi RK, , Schneider DK, , Stanfield D, , Webster KE, , Myer GD. and Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. 2016; 44: 1861– 1876. https://doi.org/10.1177/0363546515621554Crossref Medline Google Scholar

Gabriel MT, Wong EK, Woo SL, et al. Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. J. Orthop. Res. 2004; 22:85Y9.

Miller MD. The Knee and Lower Leg: Essential Orthopaedics. 1st ed. Philadelphia: Saunders, 2010.

van Melick N, van Cingel RE, Brooijmans F, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br. J. Sports Med. 2016; 50:1506Y15.

Zimny ML, Schutte M, Dabezies E. Mechanoreceptors in the human anterior cruciate ligament. Anat. Rec. 1986; 214:204Y9.

Boden BP, Dean GS, Feagin JA, Garrett WE. Mechanisms of anterior cruciate ligament injury. Orthopedics. 2000; 23:573Y8.

Hewett TE, Myer GD. The mechanistic connection between the trunk, hip, knee, and anterior cruciate ligament injury. Exerc. Sport Sci. Rev. 2011; 39:161Y6.

Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am. J. Sports Med. 1995; 23:694Y701.

Hewett TE, Ford KR, Myer GD. Anterior cruciate ligament injuries in female athletes: part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention. Am. J. Sports Med. 2006; 34:490Y8.

Fithian DC, Paxton EW, Stone ML, et al. Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee. Am. J. Sports Med. 2005; 33:335Y46.

Fu FH, Schulte KR. Anterior cruciate ligament surgery 1996. State of the art? Clin. Orthop. Relat. Res. 1996:19Y24.

Chhabra A, Starman JS, Ferretti M, et al. Anatomic, radiographic, biomechanical, and kinematic evaluation of the anterior cruciate ligament and its two functional bundles. J. Bone Joint Surg. Am. 2006; 88(Suppl. 4):2Y10.

Li G, DeFrate LE, Sun H, Gill TJ. In vivo elongation of the anterior cruciate ligament and posterior cruciate ligament during knee flexion. Am. J. Sports Med. 2004; 32:1415Y20.

Quatman CE, Kiapour AM, Demetropoulos CK, et al. Preferential loading of the ACL compared with the MCL during landing: a novel in sim approach yields the multiplanar mechanism of dynamic valgus during ACL injuries. Am. J. Sports Med. 2014; 42:177Y86.Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy. 2011; 27:1697Y705.

Grindem H, Snyder-Mackler L, Moksnes H, et al. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br. J. Sports Med. 2016; 50:804Y8.

Nagelli CV, Hewett TE. Should return to sport be delayed until 2 years after anterior cruciate ligament reconstruction? Biological and functional considerations. Sports Med. 2017; 47:221Y32.

de Jong SN, van Caspel DR, van Haeff MJ, Saris DB. Functional assessment and muscle strength before and after reconstruction of chronic anterior cruciate ligament lesions. Arthroscopy. 2007; 23:21Y8, 28.e1-3.

Shaarani SR, O’Hare C, Quinn A, et al. Effect of prehabilitation on the outcome of anterior cruciate ligament reconstruction. Am. J. Sports Med. 2013; 41:2117Y27.

Amiel D, Kleiner JB, Roux RD, et al. The phenomenon of ‘‘ligamentization’’: anterior cruciate ligament reconstruction with autogenous patellar tendon. J. Orthop. Res. 1986; 4:162Y72.

Arnoczky SP, Tarvin GB, Marshall JL. Anterior cruciate ligament replacement using patellar tendon. An evaluation of graft revascularization in the dog. J. Bone Joint Surg. Am. 1982; 64:217Y24.

Fernandes TL, Fregni F, Weaver K, et al. The influence of femoral tunnel position in single-bundle ACL reconstruction on functional outcomes and return to sports. Knee Surg. Sports Traumatol. Arthrosc. 2014; 22:97Y103.

IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 12 Ver. VI (Dec. 2015), PP 59-62 www.iosrjournals.org

Pauzenberger L, Syre´ S, Schurz M. ‘‘Ligamentization’’ in hamstring tendon grafts after anterior cruciate ligament reconstruction: a systematic review of the literature and a glimpse into the future. Arthroscopy. 2013; 29:1712Y21.

Mehta VM, Mandala C, Foster D, Petsche TS. Comparison of revision rates in bone-patella tendon-bone auto-graft and allograft anterior cruciate ligament reconstruction. Orthopedics. 2010; 33:12.

Myer GD, Ford KR, Barber Foss KD, et al. The relationship of hamstrings and quadriceps strength to anterior cruciate ligament injury in female athletes. Clin. J. Sport Med. 2009; 19:3Y8.

Nagelli CV, Hewett TE. Should return to sport be delayed until 2 years after anterior cruciate ligament reconstruction? Biological and functional considerations. Sports Med. 2017; 47:221Y32.

Sugimoto D, Myer GD, Foss KD, Hewett TE. Specific exercise effects of preventive neuromuscular training intervention on anterior cruciate ligament injury risk reduction in young females: meta-analysis and subgroup analysis. Br. J. Sports Med. 2015; 49:282Y9.

Wilk KE, Reinold MM, Hooks TR. Recent advances in the rehabilitation of isolated and combined anterior cruciate ligament injuries. Orthop. Clin. North Am. 2003; 34:107Y37.

Petsche TS, Hutchinson MR. Loss of extension after reconstruction of the anterior cruciate ligament. J Am Acad Orthop Surg. 1999;7:119–127. [PubMed] [Google Scholar]

Webster KE, Feller JA, Lambros C (2008) Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport 9:9–15

Webster KE, Feller JA (2018) Development and Validation of a Short Version of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale. Orthop J Sports Med 6:1–7

Magit D, Wolff A, Sutton K, Medvecky MJ. Arthrofibrosis of the knee. J. Am. Acad. Orthop. Surg. 2007; 15:682Y94.

Strum GM, Friedman MJ, Fox JM, et al. Acute anterior cruciate ligament reconstruction. Analysis of complications. Clin. Orthop. Relat. Res. 1990: 184Y9.

Fernandes TL, Fregni F, Weaver K, et al. The influence of femoral tunnel position in single-bundle ACL reconstruction on functional outcomes and return to sports. Knee Surg. Sports Traumatol. Arthrosc. 2014; 22:97Y103.

Mae T, Shino K, Miyama T, Shinjo H, Ochi T, Yoshikawa H, Fujie H: Single- versus two-femoral socket anterior cruciate ligament reconstruction technique: Biomechanical analysis using a robotic simulator. Arthroscopy 2001, 17:708-716.

Abramowitch SD, Papageorgiou CD, Withrow JD, Gilbert TW, Woo SL: The effect of initial graft tension on the biomechanical properties of a healing ACL replacement graft: a study in goats. J Orthop Res 2003, 21:708-715.

Nicholas SJ, D'Amato MJ, Mullaney MJ, Tyler TF, Kolstad K, McHugh MP: A prospectively randomized double-blind study on the effect of initial graft tension on knee stability after anterior cruciate ligament reconstruction. Am J Sports Med 2004, 32:1881-1886

.Shelbourne KD, Nitz P: Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med 1990, 18(3):292-299

Cascio BM, Culp L, Cosgarea AJ. Return to play after anterior cruciate ligament reconstruction. Clin. Sports Med. 2004; 23:395Y408, ix.

Delay BS, Smolinski RJ, Wind WM, Bowman DS. Current practices and opinions in ACL reconstruction and rehabilitation: results of a survey of the American Orthopaedic Society for Sports Medicine. Am. J. Knee Surg. 2001; 14:85Y91.

Adachi N, Ochi M, Uchio Y, Iwasa J, Kuriwaka M, Ito Y: Reconstruction of the anterior cruciate ligament. Single- versus doublebundle multistranded hamstring tendons. J Bone Joint Surg Br 2004, 86:515-520

Bellier G, Christel P, Colombet P, Djian P, Franceschi JP, Sbihi A: Double-stranded hamstring graft for anterior cruciate ligament reconstruction7. Arthroscopy 2004, 20:890-894.

Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y, Tohyama H, Minami A: Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 2004, 20:1015-1025.

Zelle BA, Brucker PU, Feng MT, Fu FH: Anatomical double-bundle anterior cruciate ligament reconstruction. Sports Med 2006, 36:99-108

Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL: Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 2002, 30:660-666

Shelbourne KD, Nitz P. Accelerated rehabilitation after anterior cruciate ligament reconstruction. J. Orthop. Sports Phys. Ther. 1992; 15:256Y64.

Beynnon BD, Johnson RJ, Abate JA, et al. Treatment of anterior cruciate ligament injuries, part I. Am. J. Sports Med. 2005; 33:1579Y602.

Schilaty ND, Nagelli C, Hewett TE. Use of objective neurocognitive measures to assess the psychological states that influence return to sport following injury. Sports Med. 2016; 46:299Y303.

Kvist J, Ek A, Sporrstedt K, Good L. Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg. Sports Traumatol. Arthrosc. 2005; 13:393Y7.

Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys. Ther. Sport. 2008; 9:9Y15

MARS Group; Wright RW, Huston LJ, et al. Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort. Am. J. Sports Med. 2010; 38:1979Y86.

Whitehead TS. Failure of anterior cruciate ligament reconstruction. Clin. Sports Med. 2013; 32:177Y204.

Nagelli CV, Hewett TE. Should return to sport be delayed until 2 years after anterior cruciate ligament reconstruction? Biological and functional considerations. Sports Med. 2017; 47:221Y32.

Whitehead TS. Failure of anterior cruciate ligament reconstruction. Clin. Sports Med. 2013; 32:177Y204.

Nagelli CV, Hewett TE. Should return to sport be delayed until 2 years after anterior cruciate ligament reconstruction? Biological and functional considerations. Sports Med. 2017; 47:221Y32.

MARS Group; Wright RW, Huston LJ, et al. Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort. Am. J. Sports Med. 2010; 38:1979Y86

Whitehead TS. Failure of anterior cruciate ligament reconstruction. Clin. Sports Med. 2013; 32:177Y204.

Kaeding CC, Aros B, Pedroza A, et al. Allograft versus autograft anterior cruciate ligament reconstruction: predictors of failure from a MOON prospective longitudinal cohort. Sports Health. 2011; 3:73Y81.

Whitehead TS. Failure of anterior cruciate ligament reconstruction. Clin. Sports Med. 2013; 32:177Y204

Walde´n M, Ha¨gglund M, Magnusson H, Ekstrand J. ACL injuries in men’s professional football: a 15-year prospective study on time trends and returnto-play rates reveals only 65% of players still play at the top level 3 years after ACL rupture. Br. J. Sports Med. 2016; 50:744Y50.

Whitehead TS. Failure of anterior cruciate ligament reconstruction. Clin. Sports Med. 2013; 32:177Y204.

MARS Group; Wright RW, Huston LJ, et al. Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort. Am. J. Sports Med. 2010; 38:1979Y86.

Nishimori M, Deie M, Adachi N, et al. Articular cartilage injury of the posterior lateral tibial plateau associated with acute anterior cruciate ligament injury. Knee Surg. Sports Traumatol. Arthrosc. 2008; 16:270Y4.

Published
2022-07-01
How to Cite
1.
Dr.Rajendraprasad Butala, Parelkar K, Dr.Anuragdeep Syal, Dr.Varun Chandiramani. A retrospective analysis of return to sports after 9 months in athletes in cases of anterior cruciate ligament reconstruction. ojmpc [Internet]. 2022Jul.1 [cited 2022Aug.11];28(01):27-5. Available from: https://ojmpc.com/index.php/ojmpc/article/view/151
Section
Original Article