recurrent ACL injuries

[henna]

A young soccer player, aged 18 has suffered 3 ACL injuries over the past 16 months, first the right, 7 months later the left,both HS grafts, then 5 months post surgery the left has gone again. the last 2 landing from a jump. Have you encountered someone of a similar age with this many reconstructions and have they continued to have a career in professional sport?

[injuryupdate]

In the AFL, David Schwarz of Melbourne had three recos in the space of 12 months, all on the same side. The first two were with patellar tendon grafts. He was in his early 20s.

In rugby league, Nik Kosef had 4 ACL recos in his early to mid 20s (2 on each side). The initial grafts were hamstring I think and he switched to patellar tendon.

When grafts fail, it can be a combination of surgical technique or patient factors. If you have X-rays you can usually assess whether the surgeon put the graft tunnel in the right spot.

[henna]

Did the players you mentioned who have had multiple knee reconstructions then go on to play for long periods without a problem? Do you think a players quality of life outside of football will be affected by multiple knee reconstructions? eg will they have increased risk of arthritis and if they were young and very smart then would you consider giving up football? I've only worked in sport for 3 years so i havent seen what they are like 10-20 years down the track

[hhh]

The work of Sheppard et al showed that ex-professional soccer players were at an increased risk of hop arthritic degeneration over age matched controls. Turner et al in a poorer quality study showed a similar relationship with the knee. Larsen et al documented that signs of arthritis were present in 63% of ex-elite players with MCL and/or ACL injury, while the incidence of arthritis in the group of uninjured players was 26%. They concluded that in elite football players have a serious long-term outcome of knee injuries, but also uninjured players have a higher risk of developing arthritis than the normal population. Moretz et al found a similar correlation in a younger college athletic population with a history of knee injury. HOwever, Klunder and co-workers found hip arthiritc change to be significant, but not for the knee.

I think it can be fair to say quality of life will be effected long term and they will have a significant increased risk of OA. Turner et al showed health status was also compromised.

The players mentioned continued their career but probably didn't live up to their pre-injury potential and had an early retirement. Some work in rugby league has shown over 25% of professional players attribute injury to an early retirement though.

Again I think this gets down to the trade off with exercise and injury. Moderate exercise is required for health and well being. It is a risk to punish your body to reach the levels required of an elite athlete. But you probably have a greater risk of health problems/morbity from no exercise with cardiovascular complications, diabetes, cancer etc. There is a heap of inactive people who wind up with knee/hip replacements too so because you don't do sport doesn't make you immune to this. With regards to elite sport, you probably have a greater risk of major disability from driving a car but people won't stop doing that.

[sydunisportsmed]

Pretty much you can guarantee some degree of knee arthritis if you continue to play football on a knee after tearing an ACL, whether or not you have a reconstruction. The reconstruction probably reduces but doesn't eliminate the risk of O/A.

For most elite players it is a no-brainer to keep playing after an ACL reco, but for many amateurs it should be the same easy decision for the opposite conclusion (i.e. stop playing, it's only a game, you don't want to suffer arthritis when you're older).

[anigee]

i'm not sure about professional level soccer, but i've seen a couple of older players with multiple acl injuries go on to get university scholarships!
good luck!