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 About 200,000 anterior cruciate ligament (ACL) knee injuries happen
each year in the United States, and half of those injuries are
surgically repaired, according to the American Academy of
Orthopaedic Surgeons. Surgeons usually replace the torn ligament
with a grafted replacement.
The authors reviewed the topic in 2010 and found that less than half
of patients returned to competitive level sport, but since then,
reporting on whether or not athletes return to play after surgery
has increased, they write in the British Journal of Sports Medicine.
“I think we used to presume that everyone returned to their sport
after surgery, especially since one of the main reasons why people
have surgery is because they want to return to sport,” said lead
author Clare L. Ardern. “But clearly these results show that this is
not the case.”
“I think this is lower than what we previously assumed was the case,
but having said that, this doesn’t mean that people stopped playing
sport altogether,” said Ardern, of the School of Allied Health in
the Faculty of Health Sciences at La Trobe University in Bundoora,
Australia.
“Some people may have changed the sport they played, but we were not
able to measure this in our study,” she told Reuters Health by
email.
Ardern and her team reviewed 69 new articles on ACL surgery and
return to play published between April 2010 and November 2013.
Of the 7,556 patients in total, 81 percent returned to some level of
sport after surgery, while 65 percent returned to pre-injury level
and 55 percent returned to competitive level sports.
This is an area where sports medicine specialists strive to
improve,” said Gregory D. Myer, director of the Human Performance
Laboratory at Cincinnati Children's Hospital Medical Center in Ohio.
“Our mission in sports medicine is to get everyone back to their
pre-injury activity levels regardless of the injury,” said Myer, who
was not involved in the review. “A 55 percent success rate is
certainly below the standards we aim to achieve.”
Younger players and men were more likely to return to sport than
older players or women, the researchers found.
Elite athletes were about six times more likely to return to
competitive sport than non-elite athletes.
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Not surprisingly, better physical function after surgery increased
the chances of returning to sports. Patients who were able to hop
the same distance on each leg after surgery were more likely to play
competitively again.
“These results are only generalizable if you were an athlete prior
to sustaining the injury,” Myer said.
Psychological function seemed to make a difference too.
Patients who had more fear of injuring themselves again and less
psychological readiness to play were less likely to return to
pre-injury level sport.
Psychological factors may be modifiable, unlike gender or age, which
makes mental readiness to play an important factor for doctors to
consider, the authors write.
“More and more we are recognizing that physical and mental recovery
is important to maximize the chances of returning to sport after
surgery,” Ardern said. “This means that patients and their physical
therapists need to make sure they also address both aspects.”
Patients should make sure they really understand what surgery and
rehabilitation involves, and work with their physical therapist to
set realistic goals, she said.
“Sometimes it can be useful to talk to teammates or friends who have
had an ACL injury and made a successful return to sport about what
it took and what to expect,” Ardern said. “In a team environment, if
there are teammates with ACL injuries, it can be helpful for them to
be paired together for rehabilitation to motivate each other.”
SOURCE: http://bit.ly/1BpJV8s British Journal of Sports Medicine,
online August 25, 2014.
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