to High School- and College-Level Football After Anterior Cruciate Ligament
Reconstruction: A Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study

McCullough K, Phelps K,
Spinder K, Matava M, Dunn W, Parkers R, MOON Group and Reinke E. Am J Sports
Med. Aug 2012; [e-pub ahead of print]. 10.1177/0363546512456836

Anterior cruciate ligament
(ACL) injuries are common among young football players. Surgical reconstruction
is currently the most common intervention to facilitate return to play, however
not all athletes are successful. Unfortunately, there is a lack of data
regarding how many football players return to play and what factors may
increase the risk of a player not being able to return to play. The purpose of
this study was to determine the percentage of high school and college-level football
players that returned to play at a minimum of 2 years after an ACL
reconstruction (ACLR) and the reasons why players did not return to play. All
patients were included in this study from the MOON
cohort if they reported football as one of the sports they participated in
since surgery or the sport they were playing at the time of their ACL injury.
These patients were interviewed regarding their return-to-play status,
advancement to the next level of competition, position played, performance
after surgery, and (if applicable) reasons for not returning to play. These
patients also completed the following validated questionnaires: International Knee Documentation
(IKDC), Marx Activity Scale, Knee
injury and Osteoarthritis Outcomes Score
(KOOS) sports and recreation subscore and quality of
life (QoL) subscore. Additional data were gathered regarding concomitant injury
(e.g., articular lesions or meniscal involvement) at the time of injury. One
hundred forty-seven high school and college-level football players with the
potential to continue to play in the following season were included in the
final analyses. Sixty-three percent of high school players and 69% of college
players returned to play after ACLR. Only 45% and 38% of high school and
college players respectively returned to play after surgery at their pre-injury
level. Clinically meaningful differences on several of the questionnaires were
seen between athletes (high school and college) that had not returned to play
and those that had returned to play at their pre-injury level. Of those that
had not returned to play after surgery, 50-53% of all athletes reported fear as
a contributing factor. Position played was not a predictor for the ability to
return to play after surgery. Concomitant injuries were non-significant with
respect to return to play after surgery and influence of graft type could not be
analyzed due to a wide variety of graft types among the groups.

The percentage of athletes
that returned to play after ACLR in this cohort is consistent with previous
works [ Ardern 2011, 12m follow-up, Ardern 2011,2-7 yr follow-up, Ardern 2011,  systematic
]. When further
evaluating the level of football participation, only 45% of high school
athletes and 35% of college athletes were participating in football at their
pre-injury level. These percentages are consistent with Ardern 2011
who reported that 45% of athletes were participating in sports at their
pre-injury level 2-7 years after surgery. Ardern 2012
reported that athletes that had not returned to their pre-injury level of
activity 2-7 years after surgery scored significantly lower on a custom fear
questionnaire. Consistent with this current study, fear may be a limiting
factor for all athletes that want to return to full athletic competition. This
current study confirms and continues to support the evidence that ACLR in
athletes does not guarantee full return to play. What does this mean for our
athletes? Is there a way to reduce the fear of re-injury and train athletes to
minimize their risk of re-injury? What deficits are we not addressing in our
post-operative rehabilitation in these athletes?

Written by: Kathleen
Reviewed by: Jeffrey

Related Post:

McCullough KA, Phelps KD, Spindler KP, Matava MJ, Dunn WR, Parker RD, MOON Group, & Reinke EK (2012). Return to High School- and College-Level Football After Anterior Cruciate Ligament Reconstruction: A Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study. The American Journal of Sports Medicine PMID: 22922520