Soccer is the most commonly played team sport in the world and a high-risk sport for Anterior Cruciate Ligament (ACL) injury and subsequent ACL reconstruction (ACLR). The rate of ACL injury, ACLR, return to sport and reinjury is known to be location and sport specific, and needs to be assessed in large samples in order to be accurately assessed. The aim of this study was to assess the rate of further ACL injury in patients who have undergone ACLR with hamstring autograft following soccer injuries in Australia, and determine factors associated with repeat ACL injury and return to soccer (RTS).
From a prospectively collected database, a series of 1000 consecutive ACLRs using hamstring autografts, performed in soccer players were identified. Subjects were surveyed at a minimum of five years following reconstruction including details of further ACL injuries to either knee, return to soccer or other sports and psychological readiness with the ACL-RSI score.
Of the 862 participants reviewed ACL graft rupture occurred in 85 (10%) and contralateral ACL rupture occurred in 68 (8%) within five years following the reconstruction. The 5 year ACL graft survivorship was 94% for females and 88% for males. The survivorship of the contralateral ACL (CACL) was 92% for males and 90% for females. Compared to those aged 25 or more, the odds of ACL graft rupture was increased by 4-5 times in those aged 19-25, and 3-7 times in those 18 or less. Further ACL injury to the graft or contralateral knee occurred in 44% of males under 18 years. Risk factors for further ACL injury were: younger age at time of surgery, male gender and returning to soccer. Graft diameter did not influence ACL graft rupture rates and a total of 70% of patients returned to soccer after ACLR. The mean ACL-RSI score was 59, and patients who reported more fear of reinjury on this scale were less likely to have returned to soccer.
The prevalence of ACL graft rupture (10%) and CACL survivorship (8%) were near equivalent over 5 years in this large cohort of mostly recreational Australian soccer players. ACL reconstruction with hamstring autografts is a reliable procedure for allowing 70% of patients to return to soccer in this high-risk population. Risk factors for further ACL injury are progressively younger age at time of surgery, male gender and returning to soccer. Graft diameter was not a factor in ACL graft rupture indicating other factors, particularly age, are of primary importance.