Change search
ReferencesLink to record
Permanent link

Direct link
One Anterior Cruciate Ligament injury is enough!: Focus on female football players
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
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: urn:nbn:se:liu:diva-130923DOI: 10.3384/diss.diva-130923ISBN: 9789176857366 (Print)OAI: oai:DiVA.org:liu-130923DiVA: diva2:956732
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: 2016-08-31Bibliographically approved
List of papers
1. Factors associated with playing football after anterior cruciate ligament reconstruction in female football players.
Open this publication in new window or tab >>Factors associated with playing football after anterior cruciate ligament reconstruction in female football players.
2015 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838Article in journal (Refereed) Epub ahead of print
Abstract [en]

This study investigated whether player-related factors (demographic, personality, or psychological factors) or the characteristics of the anterior cruciate ligament (ACL) injury were associated with the return to playing football in females after ACL reconstruction (ACLR). We also compared current knee function, knee related quality of life and readiness to return to sport between females who returned to football and those who had not returned. Females who sustained a primary ACL rupture while playing football and underwent ACLR 6-36 months ago were eligible. Of the 460 contacted, 274 (60%) completed a battery of questionnaires, and 182 were included a median of 18 months (IQR 13) after ACLR. Of these, 94 (52%) returned to football and were currently playing, and 88 (48%) had not returned. Multiple logistic regression analysis identified two factors associated with returning to football: 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. Current players showed higher ratings for current knee function, knee-related quality of life, and psychological readiness to return to sport (P < 0.001). Undergoing ACLR sooner after injury and high motivation to return to sports may impact a player's return to football after ACLR.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
Keyword
ACL; knee; return to sport; soccer
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-123889 (URN)10.1111/sms.12588 (DOI)26589671 (PubMedID)
Available from: 2016-01-13 Created: 2016-01-13 Last updated: 2016-08-31Bibliographically approved
2. Predictors for additional anterior cruciate ligament reconstruction: data from the Swedish national ACL register.
Open this publication in new window or tab >>Predictors for additional anterior cruciate ligament reconstruction: data from the Swedish national ACL register.
Show others...
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.

National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-115943 (URN)10.1007/s00167-014-3406-6 (DOI)000371300400036 ()25366191 (PubMedID)
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: 2016-08-31
3. Patient-Reported Knee Function, Quality of Life, and Activity Level After Bilateral Anterior Cruciate Ligament Injuries
Open this publication in new window or tab >>Patient-Reported Knee Function, Quality of Life, and Activity Level After Bilateral Anterior Cruciate Ligament Injuries
2013 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 41, no 12, 2805-2813 p.Article in journal (Refereed) Published
Abstract [en]

Background: About 12% of patients who have undergone primary anterior cruciate ligament (ACL) reconstruction sustain a contralateral ACL injury within 5 years. less thanbrgreater than less thanbrgreater thanPurpose: To investigate patient-reported knee function, quality of life, and activity level in patients with bilateral ACL injuries. less thanbrgreater than less thanbrgreater thanStudy Design: Cohort study; Level of evidence, 3. less thanbrgreater than less thanbrgreater thanMethods: A search of hospital records identified 147 patients, aged 18 to 45 years, with bilateral ACL injuries. Of these, 83 met the inclusion criteria, having had their first ACL injury up to 12 years ago with no other major injuries to the knee joint. Sixty-six of these patients (80% of total; 47% female; mean age, 29.1 7.2 years) answered a questionnaire packet. Patients who had undergone unilateral ACL reconstruction (n = 182) were used for comparison. less thanbrgreater than less thanbrgreater thanResults: Patients with bilateral ACL injuries had a median Lysholm knee score of 82 (range, 34-100). The mean EuroQol index (EQ-5D) score of the overall health status was 0.77 +/- 0.22, and the mean EQ-5D visual analog scale score was 75.5 +/- 17.6. The median Tegner activity level was 9 (range, 1-9) before any injuries, 7 (range, 1-9) before the second ACL injury, and 4 (range, 1-9) at the time of follow-up. The activity level before the second injury was higher compared with the follow-up for patients who had undergone unilateral ACL reconstruction. At follow-up, 23% of the patients with bilateral ACL injuries returned to their previous activity, and 12% of patients returned to the same level as before their injuries compared with 43% (P = .004) and 28% (P = .01) in patients who had undergone unilateral ACL reconstruction, respectively. Patients with bilateral ACL injuries had significantly lower values in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for pain, function in sports and recreation, and knee-related quality of life as well as the ACL Deficiency Quality of Life (ACL-QOL) score compared with patients who had undergone unilateral ACL reconstruction. less thanbrgreater than less thanbrgreater thanConclusion: Patients with bilateral ACL injuries reported poorer knee function and quality of life compared with those who had undergone unilateral ACL reconstruction. Their activities had changed, and they were dissatisfied with their current activity level. They had a high activity level before their first and second ACL injuries but an impaired activity level after their contralateral injury at follow-up.

Place, publisher, year, edition, pages
SAGE Publications (UK and US): No SAGE Choice, 2013
Keyword
knee, ligaments, ACL, contralateral, return to sport, subsequent injury, Tegner activity scale
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-102774 (URN)10.1177/0363546513502309 (DOI)000327473300013 ()
Note

Funding Agencies|Futurum-The Academy for Healthcare, Jonkoping County Council||Medical Research Council of Southeast Sweden||Faculty of Health Sciences at Linkoping University||Swedish National Centre for Research in Sports||

Available from: 2014-01-07 Created: 2013-12-26 Last updated: 2016-08-31

Open Access in DiVA

One Anterior Cruciate Ligament injury is enough!: Focus on female football players(1328 kB)218 downloads
File information
File name FULLTEXT01.pdfFile size 1328 kBChecksum SHA-512
201afe66cbb50408aa293aecae7e9627173355ef8958ccf85a890ee81c3ef85d6714fcfe048ca1ceba0ee9e21793da710d010c6d4e29b378571290e3a2eec0c1
Type fulltextMimetype application/pdf
omslag(454 kB)33 downloads
File information
File name COVER02.pdfFile size 454 kBChecksum SHA-512
512a48c0c85788c0520a50ddca2ae06137e21d04c33aba49a78570aceff10b861440966b3071e71380455c4ba597d6e0232887e6bc6743e2cce2edfb8bce53ce
Type coverMimetype application/pdf

Other links

Publisher's full text

Search in DiVA

By author/editor
Fältström, Anne
By organisation
Division of PhysiotherapyFaculty of Medicine and Health Sciences
PhysiotherapyOrthopedicsSport and Fitness Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 218 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 1148 hits
ReferencesLink to record
Permanent link

Direct link