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Cited by 1,313Knee injuries and reconstruction techniquesSports injuries and preventionFoot and Ankle Surgery

Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study

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Grindem, Hege, Snyder-Mackler, Lynn, Moksnes, Håvard, Engebretsen, Lars, Risberg, May Arna·2016·British Journal of Sports Medicine
DOI 10.1136/bjsports-2016-096031PMC PMC4912389
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Abstract

Background: Knee reinjury after ACL reconstruction is common and increases the risk of osteoarthritis. There is sparse evidence to guide return to sport (RTS) decisions in this population. Objectives: To assess the relationship between knee reinjury after ACL reconstruction and (1) return to level I sports, (2) timing of RTS and (3) knee function prior to return. Methods: 106 patients who participated in pivoting sports participated in this prospective 2-year cohort study. Sports participation and knee reinjury were recorded monthly. Knee function was assessed with the Knee Outcome Survey—Activities of Daily Living Scale, global rating scale of function, and quadriceps strength and hop test symmetry. Pass RTS criteria were defined as scores >90 on all tests, failure as failing any. Results: Patients who returned to level I sports had a 4.32 (p=0.048) times higher reinjury rate than those who did not. The reinjury rate was significantly reduced by 51% for each month RTS was delayed until 9 months after surgery, after which no further risk reduction was observed. 38.2% of those who failed RTS criteria suffered reinjuries versus 5.6% of those who passed (HR 0.16, p=0.075). More symmetrical quadriceps strength prior to return significantly reduced the knee reinjury rate. Conclusions: Returning to level I sports after ACL reconstruction leads to a more than 4-fold increase in reinjury rates over 2 years. RTS 9 months or later after surgery and more symmetrical quadriceps strength prior to return substantially reduce the reinjury rate.

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  • The chance of reinjury is significant if athletes do not wait at least 9 months to return to sport.

    “Current evidence suggests the chance of reinjury is significant if athletes do not wait at least 9 months to return to sport.90”

    From Anterior cruciate ligament injury: towards a gendered environmental approach (2021) · cites this paper as [90]

    The Results report that, among patients returning to level I sports after ACL reconstruction, each month of delay before nine months was significantly associated with a lower reinjury rate; 39.5% of those returning before nine months sustained reinjuries, versus 19.4% returning later. The citing sentence omits the ACL-reconstruction and level I sport limits, so the finding does not establish the same risk for athletes generally. (LLM, conf=0.86)

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Authors
Grindem, H., Snyder-Mackler, L., Moksnes, H., Engebretsen, L., & Risberg, M. A.
Affiliations
  • Norwegian School of Sport Sciences (NO)
  • Oslo Sports Trauma Research Center (NO)
  • Oslo University Hospital (NO)
Corresponding author
Grindem, Hege
ORCID
Venue
British Journal of Sports Medicine
Publisher
BMJ
Published
2016-05-09
Volume
50
Issue
13
Pages
804-808
ISSN
  • 0306-3674 (ISSN-L)
  • 1473-0480
DOI
10.1136/bjsports-2016-096031
PMC
PMC4912389
OpenAlex
W2346975471
Semantic Scholar
c01b6d404fd9987c1de0c45afce5d1aeb5e10b5c
Cited by
1,313
References
36
Citations by year
2026: 168 · 2025: 158 · 2024: 172 · 2023: 137 · 2022: 148 · 2021: 145 · 2020: 130 · 2019: 116 · 2018: 82 · 2017: 42 · 2016: 14
FWCI
93.79
Type
journal article
Language
en
Open access
Locations
  • British Journal of Sports Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • BIBSYS Brage (BIBSYS (Norway)) (acceptedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • HighWire Press Open Archive (submittedVersion)
Funders
National Institutes of Health (R37 HD037985)
Topics
  • Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Foot and Ankle Surgery
Keywords
anterior cruciate ligament reconstruction, return to sport, quadriceps strength, knee function, pivoting sports, decision rules, osteoarthritis risk
MeSH terms
Return to Sport, Adolescent, Adult, Athletic Injuries, Female, Humans, Knee Injuries, Male, Prospective Studies, Recurrence, Time Factors, Quadriceps Muscle, Muscle Strength, Young Adult, Athletes, Anterior Cruciate Ligament Reconstruction

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