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Pre-collegiate knee surgery associated with subsequent injury in college
Future research should examine clinical tests to measure mechanical function and deficits.
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Athletes who underwent precollegiate knee surgery experienced subsequent injury requiring surgery in college and were at higher risk of subsequent surgery in their ipsilateral extremity compared with other extremities, according to study results.
“More young athletes are getting surgery due to various reasons, and I think we need to be more cognizant of their results and earlier risk for injury,” Dean Wang, MD, told Orthopedics Today.
Risk of orthopedic surgery
Researchers performed a retrospective chart review of 1,141 National Collegiate Athletic Association Division I athletes who began participation from 2003 to 2009 until the completion of their student-athlete eligibility and underwent orthopedic surgery in college. Researchers evaluated the risk of orthopedic surgery using multivariate Cox and Poisson regression models, with sex and sport as additional covariates, and compared risk of subsequent surgery in the ipsilateral compared to contralateral extremity using Kaplan-Meier survival estimates and Cox proportional hazards regression.
Results showed 16.3% of athletes were treated with at least one orthopedic surgery prior to preparticipation physical evaluation. Researchers noted 181 athletes underwent 261 documented orthopedic surgeries during college, of which 127 patients had either an acute injury sustained during a game, practices or off-season training, and 57 patients underwent surgery due to documented failed nonoperative treatment or overuse injury.
Cox proportional hazards regression showed orthopedic surgery in college was univariately associated with pre-collegiate shoulder and knee surgery. Researchers found independent predictors of orthopedic surgery and primary knee injury requiring surgery in college included sport and pre-collegiate knee surgery. According to Poisson regression, the number of orthopedic surgeries in college per active seasons were univariately associated with pre-collegiate knee and foot/ankle surgery, while independent predictors of the rate of orthopedic surgeries in college included sport and pre-collegiate knee surgery.
Overall, 25% of 184 athletes with a documented laterality of a pre-collegiate orthopedic surgery received subsequent surgery in college, with 25 athletes undergoing subsequent surgery in the same extremity, according to results. Compared with other extremities, Kaplan-Meier survival estimates and Cox proportional hazards regression showed subsequent surgery in the ipsilateral extremity was more susceptible among athletes with a history of pre-collegiate surgery.
Injury prevention
According to Wang, future research should examine clinical tests that measure athletes’ mechanical function and deficits to see if those may predict any future injuries.
“For instance, there are a lot of commercial tests out there, [which] attempt to do that, but no one has looked at those tests in detail to see if they predict injury specifically in a collegiate population,” Wang said. “The ultimate goal is to develop a nomogram to assess an athlete’s risk for injury and future surgery.” – by Casey Tingle
- Reference:
- Wang D, et al. Am J Sports Med. 2016;doi:10.1177/0363546516634306.
- For more information:
- Dean Wang, MD, can be reached at the UCLA Department of Orthopaedic Surgery, 10833 Le Conte Ave., 76-143 CHS, Los Angeles, CA 90095; email: deanwangmd@gmail.com.
Disclosure: Wang reports no relevant financial disclosures.