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Br J Sports Med. 2016 Jul;50(13):804-8. doi: 10.1136/bjsports-2016-096031. Epub 2016 May 9.

Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study.

Author information

1
Department of Sports Medicine, Norwegian Research Center for Active Rehabilitation (NAR), Norwegian School of Sport Sciences, Oslo, Norway.
2
Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware, USA.
3
Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway.
4
Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway Department of Orthopaedics, Oslo University Hospital, Oslo, Norway.
5
Department of Sports Medicine, Norwegian Research Center for Active Rehabilitation (NAR), Norwegian School of Sport Sciences, Oslo, Norway Department of Orthopaedics, Oslo University Hospital, Oslo, Norway.

Abstract

BACKGROUND:

Knee reinjury after ACL reconstruction is common and increases the risk of osteoarthritis. There is sparse evidence to guide return to sport (RTS) decisions in this population.

OBJECTIVES:

To assess the relationship between knee reinjury after ACL reconstruction and (1) return to level I sports, (2) timing of RTS and (3) knee function prior to return.

METHODS:

106 patients who participated in pivoting sports participated in this prospective 2-year cohort study. Sports participation and knee reinjury were recorded monthly. Knee function was assessed with the Knee Outcome Survey-Activities of Daily Living Scale, global rating scale of function, and quadriceps strength and hop test symmetry. Pass RTS criteria were defined as scores >90 on all tests, failure as failing any.

RESULTS:

Patients who returned to level I sports had a 4.32 (p=0.048) times higher reinjury rate than those who did not. The reinjury rate was significantly reduced by 51% for each month RTS was delayed until 9 months after surgery, after which no further risk reduction was observed. 38.2% of those who failed RTS criteria suffered reinjuries versus 5.6% of those who passed (HR 0.16, p=0.075). More symmetrical quadriceps strength prior to return significantly reduced the knee reinjury rate.

CONCLUSIONS:

Returning to level I sports after ACL reconstruction leads to a more than 4-fold increase in reinjury rates over 2 years. RTS 9 months or later after surgery and more symmetrical quadriceps strength prior to return substantially reduce the reinjury rate.

KEYWORDS:

Anterior cruciate ligament; Injury; Sport

PMID:
27162233
PMCID:
PMC4912389
DOI:
10.1136/bjsports-2016-096031
[Indexed for MEDLINE]
Free PMC Article

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