Information about a piece of news titled Is it time to quit? - A critical look at return-to-play guidelines after ACL surgery
Is it time to quit? - A critical look at return-to-play guidelines after ACL surgery
Intoduction
In the British Journal of Sports Medicine (BJSM) March issue Grethe Myklebust, PT, PhD and professor Roald Bahr question whether return to high level pivoting sports is in the athletes interest after an anterior cruciate ligament (ACL) reconstruction.
Several studies have shown that the initial return rate to sport after ACL injury is high, regardless of treatment, but previously injured athletes retire at a higher rate than athletes without previous ACL injuries.One of the risks with returning to pivoting sports is reinjury to the reconstructed ACL or to other structures (menisci, cartilage or other ligaments).
The rerupture rates range from 2.3% to 13% in different sports and is a concern when advising athletes after an ACL injury. Thus, we do not know if there is an increased risk of reinjury to the reconstructed ACL when compared to a healthy knee, nor do we know the rate of meniscus or cartilage injury associated with return to sport. Nevertheless, it is clear that nearly all of the reruptures reported in the studies reviewed occurred while playing pivoting sports.Another alarming consequence is the development of early osteoarthritis (OA) after injury.
A detailed review of the literature reveals that after only ten years, as many as half of the patients display signs of OA, regardless of whether the player is reconstructed or not. It is prospected that after 15-20 years, nearly all patients will have OA after an ACL injury.Whether the increased risk of OA is a result of the original injury or continued sports participation is not known. Thus, a reconstruction of the ACL usually gives the athlete a stable knee and enables continued sport participation, but it does not secure future knee health.
It is pointed out that it is the obligation of the medical practitioners to provide adequate information of the potential consequences of returning to pivoting sports. We must enable the athlete to make an informed decision with all necessary information available, including the caveats related to future risk of knee problems and OA.
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