liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Predictors for additional anterior cruciate ligament reconstruction: data from the Swedish national ACL register.
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Department of Physiotherapy, Ryhov County Hospital, Jönköping, Sweden.ORCID iD: 0000-0002-3811-7381
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.ORCID iD: 0000-0002-6883-1471
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
Carpio Artro Clinic AB, Sophiahemmet, Stockholm, Sweden.
Show others and affiliations
2016 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, no 3, 885-894 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To identify predictors for additional anterior cruciate ligament (ACL) reconstruction.

METHODS: Patients from the Swedish national ACL register who underwent ACL reconstruction between January 2005 and February 2013 (follow-up duration 6-104 months) were included. Cox regression analyses included the following independent variables regarding primary injury: age, sex, time between injury and primary ACL reconstruction, activity at primary injury, concomitant injuries, injury side, graft type, and pre-surgery KOOS and EQ-5D scores.

RESULTS: Among ACL reconstruction procedures, 93 % involved hamstring tendon (HT) autografts. Graft type did not predict additional ACL reconstruction. Final regression models only included patients with HT autograft (n = 20,824). Of these, 702 had revision and 591 contralateral ACL reconstructions. The 5-year post-operative rates of revision and contralateral ACL reconstruction were 4.3 and 3.8 %, respectively. Significant predictors for additional ACL reconstruction were age (fourfold increased rate for <16-year-old patients vs. >35-year-old patients), time between injury and primary surgery (two to threefold increased rate for ACL reconstruction within 0-90 days vs. >365 days), and playing football at primary injury.

CONCLUSION: This study identified younger age, having ACL reconstruction early after the primary injury, and incurring the primary injury while playing football as the main predictors for revision and contralateral ACL reconstruction. This suggests that the rate of additional ACL reconstruction is increased in a selected group of young patients aiming to return to strenuous sports after primary surgery and should be taken into consideration when discussing primary ACL reconstruction, return to sports, and during post-surgery rehabilitation. LEVEL OF EVIDENCE: II.

Place, publisher, year, edition, pages
2016. Vol. 24, no 3, 885-894 p.
National Category
Physiotherapy Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-115943DOI: 10.1007/s00167-014-3406-6ISI: 000371300400036PubMedID: 25366191OAI: oai:DiVA.org:liu-115943DiVA: diva2:797600
Note

Funding agencies:The study was financially supported by Futurum-the academy for healthcare, County Council, Jonkoping, the Faculty of Health Sciences at Linkoping University, and the Swedish National Centre for Research in Sports (CIF).

Available from: 2015-03-24 Created: 2015-03-24 Last updated: 2017-12-04Bibliographically approved
In thesis
1. One Anterior Cruciate Ligament injury is enough!: Focus on female football players
Open this publication in new window or tab >>One Anterior Cruciate Ligament injury is enough!: Focus on female football players
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Anterior cruciate ligament (ACL) injury is a severe and common injury, and females have 2-4 times higher injury risk compared to men. Return to sport (RTS) is a common goal after an ACL reconstruction (ACLR), but only about two thirds of patients RTS. Young patients who RTS may have a 30-40 times increased risk of sustaining an additional ACL injury to the ipsi- or contralateral knee compared with an uninjured person.

Aims: The overall aim of this thesis was to increase the knowledge about female football players with ACLR, and patients with bilateral ACL injuries, and to identify predictors for additional ipsi- and/or contralateral ACLR.

Methods: This thesis comprises four studies. Study I and II were cross-sectional, including females who sustained a primary ACL rupture while playing football and underwent ACLR 6–36 months prior to study inclusion. In study I, 182 females were included at a median of 18 months (IQR 13) after ACLR. All players completed a battery of questionnaires. Ninety-four players (52%) returned to football and were playing at the time of completing the questionnaires, and 88 (48%) had not returned. In study II, 77 of the 94 active female football players (from study I) with an ACLR and 77 kneehealthy female football players were included. A battery of tests was used to assess postural control (the Star excursion balance test) and hop performance (the one-leg hop for distance, the five jump test and the side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using two-dimensional analyses. Study III, was a cohort study including all patients with a primary ACLR (n=22,429) registered in the Swedish national ACL register between January 2005 and February 2013. Data extracted from the register to identify predictors for additional ACLR were: patient age at primary ACLR, sex, activity performed at the time of ACL injury, primary injury to the right- or left knee, time between injury and primary ACLR, presence of any concomitant injuries, graft type, Knee injury and Osteoarthritis Outcome Score and Euroqol Index Five Dimensions measured pre-operatively. Study IV was cross-sectional. In this study, patient-reported knee function, quality of life and activity level in 66 patients with bilateral ACL injuries was investigated and outcomes were compared with 182 patients with unilateral ACLR.

Results: Factors associated with returning to football in females were; short time between injury and ACLR (0–3 months, OR 5.6; 3–12 months OR 4.7 vs. reference group >12 months) and high motivation (study I). In all functional tests, the reconstructed and uninvolved limbs did not differ, and players with ACLR and controls differed only minimally. Nine to 49% of the players with ACLR and controls had side-to-side differences and movement asymmetries and only one fifth had results that met the recommended guidelines for successful outcome on all the different tests (study II). Main predictors for revision and contralateral ACLR were younger age (fourfold increased rate for <16 vs. >35-year-old patients), having ACLR early after the primary injury (two to threefold increased rate for ACLR within 3 months vs. >12 months), and incurring the primary injury while playing football (study III). Patients with bilateral ACL injuries reported poorer knee function and quality of life compared to those who had undergone unilateral ACLR. They had a high activity level before their first and second ACL injuries but an impaired activity level at follow-up after their second injury (study IV).

Conclusions: Female football players who returned to football after an ACLR had high motivation and had undergone ACLR within one year after injury. Players with ACLR had similar functional performance to healthy controls. Movement asymmetries, which in previous studies have been associated with increased risk for primary and secondary ACL injury, occurred to a high degree in both groups. The rate of additional ACLR seemed to be increased in a selected group of young patients who desire to return to strenuous sports like football quickly after primary ACLR. Sustaining a contralateral ACL injury led to impaired knee function and activity level.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. 97 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1525
National Category
Physiotherapy Orthopedics Sport and Fitness Sciences
Identifiers
urn:nbn:se:liu:diva-130923 (URN)10.3384/diss.diva-130923 (DOI)9789176857366 (ISBN)
Public defence
2016-09-30, Berzeliussalen, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-08-31 Created: 2016-08-31 Last updated: 2017-02-15Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Authority records BETA

Fältström, AnneHägglund, MartinMagnusson, HenrikKvist, Joanna

Search in DiVA

By author/editor
Fältström, AnneHägglund, MartinMagnusson, HenrikKvist, Joanna
By organisation
Division of PhysiotherapyFaculty of Medicine and Health Sciences
In the same journal
Knee Surgery, Sports Traumatology, Arthroscopy
PhysiotherapyMedical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 305 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf