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Background: Studies on subsequent anterior cruciate ligament (ACL) ruptures and career length in male professional football players after ACL reconstruction (ACLR) are scarce.Aim: To investigate the second ACL injury rate, potential predictors of second ACL injury and the career length after ACLR.Study Design: Prospective cohort study.Setting: Men's professional football.Methods: 118 players with index ACL injury were tracked longitudinally for subsequent ACL injury and career length over 16.9 years. Multivariable Cox regression analysis with HR was carried out to study potential predictors for subsequent ACL injury.Results: Median follow-up was 4.3 (IQR 4.6) years after ACLR. The second ACL injury rate after return to training (RTT) was 17.8% (n=21), with 9.3% (n=11) to the ipsilateral and 8.5% (n=10) to the contralateral knee. Significant predictors for second ACL injury were a non-contact index ACL injury (HR 7.16, 95% CI 1.63 to 31.22) and an isolated index ACL injury (HR 2.73, 95% CI 1.06 to 7.07). In total, 11 of 26 players (42%) with a non-contact isolated index ACL injury suffered a second ACL injury. RTT time was not an independent predictor of second ACL injury, even though there was a tendency for a risk reduction with longer time to RTT. Median career length after ACLR was 4.1 (IQR 4.0) years and 60% of players were still playing at preinjury level 5 years after ACLR.Conclusions: Almost one out of five top-level professional male football players sustained a second ACL injury following ACLR and return to football, with a considerably increased risk for players with a non-contact or isolated index injury. [ABSTRACT FROM AUTHOR]

Background: A few small studies have reported on the mechanisms of ACL injury in professional male football.Aim: To describe the mechanisms, situational patterns and biomechanics (kinematics) of ACL injuries in professional male football matches.Methods: We identified 148 consecutive ACL injuries across 10 seasons of professional Italian football. 134 (90%) injury videos were analysed for mechanism and situational pattern, while biomechanical analysis was possible in 107 cases. Three independent reviewers evaluated each video. ACL injury epidemiology (month), timing within the match and pitch location at the time of injury were also reported.Results: 59 (44%) injuries were non-contact, 59 (44%) were indirect contact and 16 (12%) were direct contact. Players were frequently perturbed immediately prior to injury. We identified four main situational patterns for players who suffered a non-contact or an indirect contact injury: (1) pressing and tackling (n=55); (2) tackled (n=24); (3) regaining balance after kicking (n=19); and (4) landing from a jump (n=8). Knee valgus loading (n=83, 81%) was the dominant injury pattern across all four of these situational patterns (86%, 86%, 67% and 50%, respectively). 62% of the injuries occurred in the first half of the matches (p<0.01). Injuries peaked at the beginning of the season (September-October) and were also higher at the end of the season (March-May).Conclusions: 88% of ACL injuries occurred without direct knee contact, but indirect contact injuries were as frequent as non-contact injuries, underlying the importance of mechanical perturbation. The most common situational patterns were pressing, being tackled and kicking. [ABSTRACT FROM AUTHOR]

Outcomes following long-term injuries such as anterior cruciate ligament rupture are unsatisfactory. To improve outcomes, we must improve rehabilitation practices, One aspect of the return-to-sport process that has received limited attention is on-field rehabilitation. This article is part 1 of a 2 -part series aimed at discussing the important elements of on-field rehabilitation and illustrating how they can be applied across a 5-stage on-field rehabilitation program following anterior cruciate ligament reconstruction. The intention of on-field rehabilitation is to support athletes in their transition back to sport after injury, from standard rehabilitation to return to the team or practice. In part 1, we describe 4 pillars of high-quality on-field rehabilitation: (1) restoring movement quality, (2 ) physical conditioning, (3) restoring sport-specific skills, and (4) progressively developing chronic training load. In part 2, we describe how these pillars may be combined into a 5-stage on-field rehabilitation program to help athletes transition to team practice and match play following anterior cruciate ligament reconstruction. [ABSTRACT FROM AUTHOR]

The author decided to opt for Open Choice and to make the article an Open Access publication. [ABSTRACT FROM AUTHOR]

Background: A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sport and their previous activity level., Purpose: The aim of the Panther Symposium ACL Injury Return to Sport Consensus Group was to provide a clear definition of RTS after ACL injury and a description of the RTS continuum as well as provide clinical guidance on RTS testing and decision-making., Study Design: Consensus statement., Methods: An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence., Results: Key points include that RTS is characterized by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS and, ultimately, return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum, with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors, and concomitant injuries., Conclusion: The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing, and methods for the biological assessment of healing and recovery., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: C.F. has received research support from Zimmer Biomet, consulting fees from Karl Storz and Medacta, speaking fees from Medacta, and royalties from Karl Storz. S.L.S. has received research support from Zimmer Biomet and consulting fees from Arthrex, Conmed, Flexion Therapeutics, JRF Ortho, Olympus, Smith & Nephew, and Vericel. B.P.L. has received royalties from Wolters Kluwer Health–Lippincott Williams & Wilkins. Contributing authors have the following disclosures: L.E. has received grants from Smith & Nephew. C.C.K. has received grant support from DJO, educational support from CDC Medical, consulting fees from Zimmer Biomet, and nonconsulting fees from Arthrex. R.K. has received grants from Smith & Nephew, Zimmer Biomet, Stryker, and Johnson & Johnson; consulting fees from Medacta International, Arthrex, Japan Tissue Engineering, and Hirosaki Life Science Innovation; and speaking fees from Arthrex, Smith & Nephew, Zimmer Biomet, Johnson & Johnson, and Japan Tissue Engineering. V.M. has received educational support from Arthrex and Smith & Nephew. S.J.R. has received educational support from Mid-Atlantic Surgical. R.S. has received personal fees from Medacta International. C.v.E. has received educational support from Arthrex, Mid-Atlantic Surgical, and Smith & Nephew and grant support from DJO and Zimmer Biomet. D.V. has received educational support from Mid-Atlantic Surgical and hospitality payments from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)

Unlabelled: Surgical reconstruction of an injured anterior cruciate ligament (ACL) leads to full recovery of function and sports activity in a high percentage of cases. The aim of the present study was to analyze variables related to the patient, the surgical technique and the post-surgical rehabilitation methods, seeking to identify predictors of outcome and recovery time after ACL reconstruction. One hundred and four patients (81 M, 23 F) undergoing a step-based rehabilitation protocol after ACL reconstruction were evaluated. 43.2% of them had an isolated ACL lesion, whereas 56.8% had one or more concurrent injuries. Data relating to personal characteristics, surgery and post-operative management were collected and analyzed for correlation. Clinical outcome was evaluated with IKDC subjective score and the Tegner score, and the time to reach full recovery was noted as well. Young patients with a higher pre-injury Tegner activity level or who practice sport at professional level, no concurrent capsular lesions and no postoperative knee bracing had better clinical results and took shorter time to recover. Also, a higher percentage of on-the-field rehabilitation sessions, and absence of significant muscle strength deficits at the first knee isokinetic test emerged as rehabilitation-related factors leading to a better post-surgical outcome. Personal, surgical and rehabilitation factors should be considered in order to optimize patient management and maximize the expected results. Further studies are needed to find the strongest factors in different patients., Level of Evidence: Level IV, retrospective study.