LAS VEGAS, Nevada—Anterior cruciate ligament (ACL) repairs are becoming more common in younger athletes. These reconstructions need a full year of healing time, but they are less likely than meniscectomy to shorten a professional football career, according to reports at the 2009 American Academy of Orthopaedic Surgeons meeting.^1-3 The repaired ligament holds up for 20 years or more in most patients.⁴

"What's happening is that usually by about age 12, children choose the sport in which they are determined to excel and then participate in that sport year round,” said Darren L. Johnson, MD, orthopaedic surgeon and director of sports medicine at the University of Kentucky School of Medicine. “Participating without taking time off, playing on multiple teams at one time and at higher competition levels, makes young athletes more susceptible to ACL tears at a younger age." The risk is particularly high among athletes who play soccer, football, volleyball, or basketball.

Male, female athletes return to play at same rates after ACL repair

K. Donald Shelbourne, MD, of Indianapolis, Indiana, reported that male and female school-aged basketball and soccer players return to play at the same rates and at the same level. Of the 402 athletes Dr. Shelbourne studied, at least 20% continued on to compete in their sport in college.

All of the patients were injured while competing in basketball or soccer, were younger than 17 at the time of surgery, and had no previous ACL injuries. “For basketball, 87% of both women and men returned to compete in high-school basketball after surgery, and 21% of women and 17% of men went on to compete in basketball in college. The mean time to return to full participation in basketball was 5.2 ± 2.1 months for women and 5.3 ± 2.2 months for men (P=0.92). For soccer, 93% of women and 80% of men returned to compete in high school soccer after surgery (P=0.13), and 33% of women and 24% of men went on to compete in soccer in college (P=0.47). The mean time to return to full participation in soccer was 5.1 ± 1.9 months for women and 5.1 ± 2.0 for men (P=1.0),” Dr. Shelbourne reported.

Prior ACL repair less problematic than meniscectomy for pro football players

Corey S. Gill, MD, of Saint Louis MO, reported, “Meniscectomy shortens the career of a professional football players; ACL reconstruction does not.” Dr. Gill also found that having both ACL reconstruction and meniscectomy shortens an athlete's career more than either surgery alone.

Dr. Gill used a database with the injury histories and National Football League (NFL) career statistics of athletes from 1987-2000. Athletes (n=54) with a history of meniscectomy and/or ACL surgery were matched to controls (n=29) without a history of any previous surgery. Matching was by position, year drafted, round drafted, and additional injury history. The analysis showed that:

• Meniscectomy reduced the length of career by 1.4 years and games played from 85 to 62
• ACL surgery did not significantly reduce career length or number of games played
• ACL reconstruction plus meniscectomy reduced playing years from 6.1 to 4.0 and number of games played from 73 to 41, but this was not statistically significant in this sample of 11 patients.
• Compared to athletes with only meniscectomy or ACL reconstruction, combined ACL reconstruction and meniscectomy significantly shortened careers in terms of games started (7.9 vs. 35.1, P<0.01), games played (41 vs. 63, P=0.07) and years in the league (4.0 vs. 5.8, P=0.08).

Repair ACL has excellent function for 20 years

Karen K Briggs, MPH, Vail, CO, reported that, with proper patient selection, patients over 40 can expect excellent function and high activity levels for 20 years after ACL reconstruction.

The patients in this 20-year follow-up study had undergone a bone-patellar ligament-bone intra-articular reconstruction of the anterior cruciate ligament at ages 40-60. Five of 72 patients required total knee arthroplasty (8%) at an average of 17 years following their ACL reconstructions. Average age at follow-up was 63 years, and the patients remained very satisfied with their ACL outcomes, with little pain and high functional levels. “No patients had disability due to their knee,” Briggs said.

ACL reconstruction: translating research into practice

Dr. Johnson stressed the importance of allowing time for complete healing of an ACL reconstruction before returning to sports activity. “This is a year long recovery, but many young athletes do not understand this,” Dr. Johnson said. “The reason you cannot return to playing after just a few months is because you do not have the strength back in your leg, and the repaired ligament is not strong enough. Coming back too early is a real problem and puts the athlete at a higher risk for re-injury.”

Dr. Johnson says young athletes need to understand this fact in order to avoid further problems. “Having two ACLs replaced by the time athletes are in high school is not uncommon, but once it happens, it is very unlikely their knees will ever be normal,” he warned.

References

1. Shelbourne KD.  Return to Basketball and Soccer After ACL Reconstruction in Competitive School-Aged Athletes. Oral presentation at the American Academy of Orthopaedic Surgeons (AAOS) 2009 Annual Meeting, Las Vegas, 25 February 2009, Presentation No: 010.
2. Gill CS, Lyman S, Barnes RP, et al. Effect of ACL reconstruction and meniscectomy on career length in NFL athletes: a case control study. Poster Presentation at the American Academy of Orthopaedic Surgeons (AAOS) 2009 Annual Meeting, Las Vegas, 25 February 2009. Presentation Number: P406.
3. Karen K Briggs. ACL Reconstruction in Patients 40 Years of Age and Older: 20 Year Follow-up. Oral presentation at the American Academy of Orthopaedic Surgeons (AAOS) 2009 Annual Meeting, Las Vegas.