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Nearly 90% participation in sports activity 12 years after non-surgical management for anterior cruciate ligament injury relates to physical outcome measures

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Traditionally reconstructive surgery is recommended for patients planning to return to sport (RTS), especially to pivoting sports after anterior cruciate (ACL) rupture. Recent trends focus on delaying or avoiding surgery as some studies have found similar rates of RTS following both surgical and conservative management. This study aimed to establish long-term RTS levels in ACL-ruptured individuals treated conservatively, and to investigate the relationship between outcome measures and RTS, in particular, pivoting sports.

Method

Fifty-five patients from a cohort of 132 ACL-deficient patients were followed-up for  12 (IQR 8,19) years post injury. Mean-aged 42 years, 22 patients were females and 33 males, 35 had meniscal injuries. Patients were treated with physiotherapy focussing on strength and dynamic stability training and not reconstructive surgery. Return to sport was measured on a 6-point scale. Outcome measures included: objective stability, subjective stability, quadriceps and hamstring strength. Spearman’s rho and Chi-square tests were used to assess the relationship between RTS and outcome measures.

Results

Eighty-nine percent of ACL-deficient patients were currently participating in sport despite a 38% increase in anterior translation (p < 0.001) and a 7.5% loss of quadriceps strength (p = 0.004) compared to the contralateral side. Six patients (11%) did not RTS, ten (18%) returned to safe sports, five (9%) returned to running and 16 (29%) to non-strenuous sports involving limited twisting. Eighteen patients (33%) returned to pivoting sports, 12(22%) at recreational level and six (11%) at competitive level. The level of RTS was related to subjective stability (p = 0.002), and to quadriceps and hamstring strength of the injured leg (p < 0.001). Patients able to return to pivoting sports differed significantly from those not doing so in outcome measures including objective (p = 0.022) and subjective stability (p = 0.035), and quadriceps strength (p = 0.044).

Conclusions

Eighty-nine percent of ACL-ruptured individuals treated conservatively lead an active sporting life. One-third returned to pivoting sports.  Overall RTS was related to subjective and objective stability and quadriceps and to a lesser extent hamstring strength. This finding reinforced the importance of dynamic stability training as an initial treatment option in most cases.

Level of evidence

III.

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Abbreviations

ACL:

Anterior cruciate ligament

RTS:

Return to sport

AP:

Anterio-posterior

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Funding

No funding has been received for this study.

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Authors and Affiliations

  1. Private Practice, Nambour, Australia

    Susan L. Keays & Anthony C. Keays

  2. School of Health and Sports Sciences, The University of the Sunshine Coast, Sippy Downs, QLD, Australia

    Susan L. Keays

  3. School of Psychology and Institute for Teaching and Learning Innovation, The University of Queensland, St Lucia, Brisbane, QLD, Australia

    Peter Newcombe

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Contributions

SLK conceived of the study, recruited the patients, was responsible for the data collection and the initial manuscript draft. PN assisted with the study design and was responsible for the data analysis and interpretation. ACK assisted with study concept and design and assisted with assessment and manuscript draft. All authors read and approved the final manuscript.

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Correspondence to Susan L. Keays.

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The authors have no conflicts of interest.

Ethical Approval

Work has been approved by the Medical Research Ethics Committee of The University of Queensland, Australia.

Informed Consent

All subjects signed an informed consent form before data collection took place.

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Keays, S.L., Newcombe, P. & Keays, A.C. Nearly 90% participation in sports activity 12 years after non-surgical management for anterior cruciate ligament injury relates to physical outcome measures. Knee Surg Sports Traumatol Arthrosc 27, 2511–2519 (2019). https://doi.org/10.1007/s00167-018-5258-y

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