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Young athletes return too early to knee-strenuous sport, without acceptable knee function after anterior cruciate ligament reconstruction
ESSKA Academy. Beischer S. May 11, 2018; 218189
Susanne Beischer
Susanne Beischer
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Abstract
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Objectives: The purpose of this study was to evaluate the return to knee-strenuous-sport rate, muscle function and subjective knee function among adolescent athletes (15-20 years of age) and adult athletes (21-30 years of age) 8 and 12 months after a primary anterior cruciate ligament (ACL) reconstruction.

Methods: This is a prospective cohort study with cross-sectional data from a rehabilitation outcome register, 8 and 12 months after a primary ACL reconstruction, with results from five tests of muscle function, the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Activity Scale (Tegner). A total of 270 (51% women) athletes, aged 15-30 years, were included 8 months after ACL reconstruction. At 12 months 203 (51% women) athletes were included. All athletes were, prior their ACL injury, involved in knee-strenuous sport, defined as Tegner ≥ 6. The return to knee-strenuous-sport rates and the rate of achieving a limb symmetry index of ≥ 90% in all five tests of muscle function, defined as muscle function recovery, and subjective knee function, as measured with the KOOS, were compared between age groups. The Mann-Whitney U test and an independent t-test were used for non-parametric and parametric data respectively. The chi-square test was used to analyse associations between categorical variables. All significance tests were conducted at the 5% significance level.

Results: The adolescent athletes had, 8 months after ACL reconstruction, a higher (50%) (p = 0.04) return to knee-strenuous-sport rate, compared with the adult athletes (38%). At the 12-month follow-up, no difference was found between the age groups; 74%, and 63% respectively. At the 8-month follow-up, 29% of the athletes, in both age groups, who had returned to knee-strenuous sport, had recovered their muscle function in all five tests of muscle function. At the 12-month follow-up, the corresponding results were 20% for the adolescents and 28% for the adult patients. No difference in mean KOOS scores was found between the age groups at 8 or 12 months after ACL reconstruction.

Conclusions: Adolescent athletes return to a higher extent and too early to knee-strenuous sports compared with adult athletes after a primary ACL reconstruction. Worrying is that more than 70% of young athletes, 15-30 years old, make their return to knee-strenuous sport, without recovering their muscle function. In order to set realistic expectations, clinicians are recommended to ensure that young athletes receive information about not to return before muscle function is recovered and that this may take longer time than 12 months.

Keywords:
Adolescents, knee, rehabilitation, muscle function, return to sport, register study
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