The risk of recurrence of anterior cruciate ligament (ACL) tear is greater in athletes who do not obtain a high score in tests that measure their ability to return to sports competition.
Forming an “X” at the knee joint, the anterior cruciate ligament (ACL) helps control the rotation of the knee. Very painful and debilitating, its tear is quite common among athletes playing sports with sudden stops and changes of direction, such as football and basketball.
Even when they receive ACL reconstruction surgery, the risk of tear recurrence and graft failure remains high among top athletes: around 20% of surgeries fail, doctors estimate. This surgery involves grafting pieces of tissue, including one of the hamstring tendons or the kneecap tendon (patellar tendon), to rebuild the ligament damaged by the injury
This risk is all the greater in young athletes when they do not obtain a score of at least 90% on a series of tests measuring their ability to return to competition, estimates a new study presented at the annual meeting of the American Orthopedic Society of Sports Medicine.
A 3 times higher risk of recurrence
To reach this conclusion, orthopedic surgeons and sports medicine professionals have established several return-to-sport criteria to help guide patients when considering competitive sports following a knee injury. Among these criteria, quadriceps strength is one of the most important measures for predicting the risk of additional anterior cruciate ligament injuries.
These criteria were tested for 2 years by the team of Dr. Mark Paterno, a researcher in the Division of Sports Medicine at Cincinnati Children’s Hospital, with 181 patients aged 16 on average. Each young patient was evaluated on 6 tests, including isometric quadriceps strength and 4 functional jump tests. The participants were then ranked according to their success rate for the 6 criteria, and whose overall score is equal to 100.
Objective of such an experiment: to determine whether the fact of succeeding in the six measures made it possible to reduce or not the risk of a second ACL injury in the 24 months following the return to sport. Of the 181 patients recruited, 39 suffered a second ACL injury with 18 graft failures and 21 contralateral ACL tears during the first 24 months after surgery. At the time of return to sport assessment, 57 patients had scored 90% or better on all tests.
When assessing the individual return to sport endpoint, patients who did not achieve 90% quadriceps strength were 84% less likely to suffer from graft failure but had a 3 must higher risk of sustaining an ACL injury.
A promising new surgery for ACL tears
According to doctors, there is currently no way to 100% identify young patients at high risk of tearing following a first injury to the anterior cruciate ligament. Further studies are therefore needed to “find out whether other factors may contribute to a predictive model of future limb-specific ACL injury,” Dr. Paterno said.
This work follows another study unveiled last May at the ISAKOS 2019 Congress, which showed that a complementary surgical procedure called lateral extra-articular tenodesis (TEL) can provide additional support and reduced the risk of osteoarthritis by 65%. failure of the anterior cruciate ligament graft.