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. 2020 Nov/Dec;12(6):587-597.
doi: 10.1177/1941738120912846. Epub 2020 May 6.

One in 5 Athletes Sustain Reinjury Upon Return to High-Risk Sports After ACL Reconstruction: A Systematic Review in 1239 Athletes Younger Than 20 Years

Sue Barber-Westin  1 , Frank R Noyes  1
Affiliations

One in 5 Athletes Sustain Reinjury Upon Return to High-Risk Sports After ACL Reconstruction: A Systematic Review in 1239 Athletes Younger Than 20 Years

Sue Barber-Westin et al. Sports Health. 2020 Nov/Dec.

Abstract

Context: Anterior cruciate ligament (ACL) reconstruction (ACLR) is frequently performed in patients younger than 20 years whose goal is to return to sport (RTS). Varying reinjury rates have been reported, and the factors responsible are unclear. Studies differ with regard to age, graft type, surgical techniques, postoperative rehabilitation, RTS guidelines, and methods used to determine ACL failures.

Objective: To determine RTS rates; the effect of participation in high-risk sports, sex, and graft type on ACL reinjury rates; and whether objective test criteria before RTS correlate with lower reinjury rates.

Data sources: A systematic review of the literature from inception to May 31, 2019, was conducted using the PubMed and Cochrane databases.

Study selection: Studies on transphyseal ACLR in athletes <20 years old with a minimum mean follow-up of 2 years that reported reinjury rates, the number that RTS, and detailed the type of sport were included.

Study design: Systematic review.

Level of evidence: Level 4.

Results: A total of 1239 patients in 8 studies were included; 87% returned to sport and 80% resumed high-risk activities. Of the patients, 18% reinjured the ACL graft and/or the contralateral ACL. Nine percent of patellar tendon autografts and 15% of hamstring autografts failed (odds ratio [OR], 0.52; P = 0.002). Of reinjuries, 90% occurred during high-risk sports. Male patients had a significantly higher rate of ACL graft failure than female patients (OR, 1.64; P = 0.01). There was no sex-based effect on contralateral ACL injuries. Only 1 study cited objective criteria for RTS.

Conclusion: A high percentage of athletes returned to sport, but 1 in 5 suffered reinjuries to either knee. Male patients were more likely to reinjure the ACL graft. Objective criteria for RTS were rarely mentioned or not detailed. The need for testing of knee stability, strength, neuromuscular control, agility, and psychological measures before RTS remains paramount in young athletes.

Keywords: ACL reconstruction; ACL reinjury; return to sport; transphyseal ACL reconstruction.

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Conflict of interest statement

The authors report no potential conflicts of interest in the development and publication of this article.

Figures

Figure 1.
Figure 1.
Percentages of anterior cruciate ligament (ACL) reconstruction failure according to the type of graft. BPTB, bone–patellar tendon–bone; NP, not provided.
Figure 2.
Figure 2.
The percentage of patients that suffered tears to the anterior cruciate ligament (ACL) graft, contralateral ACL, and either knee are shown for each study.
See this image and copyright information in PMC

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