So as you can see, pretty alarming statistics from a typical group of ACLR patients that we all might come across in our daily practice.
The biggest concern however is that with over 75% of ACLR patients returning back to high risk cutting/pivoting sports WITHOUT passing discharge criteria, it significantly increases their risk of graft re-injury or an ACL injury to their other limb.
This was shown in a recent paper on professional male soccer players who were shown to have a 4x greater risk of ACL re-injury when they returned to sport without passing all discharge criteria (Kyritsis et al, 2016).
Take home messages:
To lower the risk of ACLR injury and increase the likelihood of returning back to pre-injury sport, ACLR patients need to:
1) Conduct a period of supervised rehab for at least 6 months, that includes hopping, jumping and landings and a structured return to sport plan
2) Pass a series of strength and function tests before being allowed to return to unrestricted training and sport
- Toole, A.R., et al., Young Athletes Cleared for Sports Participation After Anterior Cruciate Ligament Reconstruction: How Many Actually Meet Recommended Return-to-Sport Criterion Cutoffs? J Orthop Sports Phys Ther, 2017. 47(11): p. 825-833.
- Welling, W., et al., Low rates of patients meeting return to sport criteria 9 months after anterior cruciate ligament reconstruction: a prospective longitudinal study. Knee Surg Sports Traumatol Arthrosc, 2018.
- Edwards, P.K., et al., Patient Characteristics and Predictors of Return to Sport at 12 Months After Anterior Cruciate Ligament Reconstruction: The Importance of Patient Age and Postoperative Rehabilitation. Orthop J Sports Med, 2018. 6(9): p. 2325967118797575.
- Ardern, C.L., et al., Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med, 2011. 45(7): p. 596-606.
- Kyritsis, P., et al., Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med, 2016. 50(15): p. 946-51.