Return to sport seen in high rate of competitive athletes after revision ACL reconstruction, rehab

CHICAGO — Revision ACL reconstruction with a patellar tendon autograft combined with perioperative rehabilitation can allow return-to-sport in a high rate of young, competitive athletes at the same level, according to a presenter here at the American Orthopaedic Society for Sports Medicine Annual Meeting.

“Bone tendon patella bone is the best graft available for allowing athletes to get back to competitive activities,” Rodney W. Benner, MD, said.

In the prospective study, patients who played twisting/pivoting sports underwent a perioperative rehabilitation program which emphasized limiting postoperative hemarthrosis, obtaining full range of motion and achieving quadriceps muscle control before participating in an aggressive strengthening and functional progression program. Patients were grouped by age and competitive sport levels: high school age (> 17.5 years), college (18 years to 21.9 years) or recreational (22 years to 35 years).

Rodney W. Benner

A subjective activity survey was used to determine what specific sport and sport level patients participated in before and after surgery. Researchers also determined subsequent ACL injury rate to either knee.

The researchers found 74% of high school, 74% of college and 62% of recreational athletes returned to play the same sport at the same level. All high school and college athletes who were not able to return to competition were able to play the same sport at the recreational level.

Benner and colleagues noted 2.3% of patients in the high school, 5.1% of patients in the college and 3.4% of patients in the recreational group had subsequent ACL graft tears after revision surgery. ACL injury rate to either knee after revision ACL reconstruction was 5%. Two patients in the high school, 3 patients in the college and 4 patients in the recreational group had a subsequent ACL tear.

One patient in each of the high school and college groups, and 2 patients in the recreational group had a subsequent ACL tear in the contralateral knee. The mean International Knee Documentation Committee subjective total score was 86.1 points at 2 years and 76.7 points at 7.2 years postoperatively. The mean modified Noyes total score was 89.7 points 2 years postoperatively and 83.7 points at long-term follow up.

“Retear and contralateral ACL tear rates were lower than expected and may even be lower than primary ACL reconstructions. We hypothesize this is because while patients are getting back to competition, they may be doing so at a lower intensity and with a lower amount of remaining athletic exposure,” Benner said.

Reference:
Benner RW. Paper #3. Presented at the American Orthopaedic Society for Sports Medicine Annual Meeting; July 11-14, 2013; Chicago.
Disclosure: Benner has no relevant financial disclosures.