High return-to-play rates found in elite athletes after multiligament knee injuries
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Elite athletes with multiligament knee injuries experienced high return-to-play and reoperation rates, according to study results presented at the American Orthopaedic Society for Sports Medicine Annual Meeting.
“There's been a well-documented increase in both isolated and multiple ligament knee injuries in athletes,” Kyle Borque, MD, Houston Methodist Hospital, said during the meeting, which was held as a virtual event. “While historically multiple ligament knee injuries have been considered career ending, there's very limited data that actually assesses their treatment in this specialized patient population; only three studies that are available to date, with return-to-play rates ranging from 22% to 64%.”
In a retrospective review of multiple ligament knee injuries, investigators analyzed results of 109 elite athletes for operation outcomes including return-to-play rate, return-to-play time and rate of reoperation. Each surgery aimed to abolish ligament laxity while ensuring a strong enough construct to allow for safe early range of motion.
Overall study results yielded a return-to-play rate of 85.3%, with a 71.5% rate of returning to play at the same level. These results also showed an average return to play of 10.2 months for athletes who underwent ACL and medial collateral ligament surgery vs. 12.9 months for athletes who underwent ACL and PCL surgery. Subsequent operation was needed in 36.7% of study athletes.
“This is a very specialized elite athlete population meaning that they're very motivated and have access to the highest levels of physical therapy ... in an effort to return to play they give good feedback on whether their constructs are strong enough,” Borque concluded. “This is the largest study to date, focusing on elite athletes with multiple ligament knee injuries, through a combination of repair and reconstruction collaterals, high return-to- play rates can be achieved though high reoperation rates are given.”
Perspective
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Alan G. Shamrock, MD
The featured study retrospectively examined return-to-play (RTP) rates and the timing required to do so in a cohort of elite athletes following multiligament knee injury (MLKI). They report a high return-to-play rate of 85.3%, with 71.5% of elite athletes returning to play at the same level.
MLKIs present a difficult injury pattern to study given their rarity, variable ligament injury patterns, high complication rate and wide variety of associated injuries. The authors should be commended on describing a relatively homogenous group of patients (elite athletes), which certainly provides us with more generalizable information than most MLKI cohort studies in the literature. Further work is needed to better understand the relationship of specific ligament injury patterns and/or treatment decisions (repair vs. reconstruction) on RTP rates, although this study is certainly a step in the right direction.
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Borque K, et al. Multiligament knee injuries in elite athletes: Return-to-play rates, timing and complications. Presented at American Orthopaedic Society for Sports Medicine; July 8-9, 2020 (virtual meeting).
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