Risk of Anterior Cruciate Ligament Injury in Athletes on Synthetic Playing Surfaces: A Systematic Review.

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Abstract

The effect of synthetic playing surfaces on the risk of injury in athletes is frequently debated in the orthopaedic literature. Biomechanical studies have identified increased frictional force at the shoe-surface interface, theoretically increasing the risk of injury relative to natural grass. This increase in frictional force is potentially relevant for the risk of anterior cruciate ligament (ACL) rupture, where noncontact mechanisms are frequent. However, clinical studies examining this issue have shown mixed results.

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Most cited references 28

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Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play.

Clare L. Ardern, Kate E. Webster, Nicholas F Taylor … (2011)

An athlete's intention to return to sport following anterior cruciate ligament (ACL) injury is a major indication for surgical intervention. The purpose of this review was to determine postoperative return-to-sport outcomes after ACL reconstruction surgery. Meta-analysis and systematic review Electronic databases including Medline, Embase, SPORTDiscus and CINAHL were searched from the earliest possible entry to April 2010. Studies were included that reported the number of patients returning to sports participation following ACL reconstruction surgery. The results were presented using the World Health Organization's International Classification of Functioning, Disability and Health as a framework and combined using proportion meta-analyses. Forty-eight studies evaluating 5770 participants at a mean follow-up of 41.5 months were included for review. Overall, 82% of participants had returned to some kind of sports participation, 63% had returned to their preinjury level of participation, and 44% had returned to competitive sport at final follow-up. Approximately 90% of participants achieved normal or nearly normal knee function when assessed postoperatively using impairment-based outcomes such as laxity and strength, and 85% when using activity-based outcomes such as the International Knee Documentation Committee knee evaluation form. Fear of reinjury was the most common reason cited for a postoperative reduction in or cessation of sports participation. The relatively low rate of return to competitive sport despite the high rates of successful outcome in terms of knee impairment-based function suggests that other factors such as psychological factors may be contributing to return-to-sport outcomes.

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Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery.

Julian A Feller, Clare L. Ardern, Nicholas F Taylor … (2011)

Most people have not returned to their preinjury level of sports participation at 12 months after anterior cruciate ligament (ACL) reconstruction surgery. Twelve months' follow-up may be too early to assess return-to-sport outcomes accurately. This study was undertaken to evaluate the medium-term return-to-sport outcomes after ACL reconstruction surgery. Case series; Level of evidence, 3. A self-report questionnaire was used to collect data at 2 to 7 years after ACL reconstruction surgery regarding preinjury sports participation, postoperative sports participation, and subjective knee function. The main inclusion criteria were participation in regular sports activity before injury and the attendance at routine surgical follow-up appointments. A total of 314 participants (mean age, 32.5 ± 10.2 years) were included at a mean 39.6 ± 13.8 months after ACL reconstruction surgery. At follow-up, 45% were playing sport at their preinjury level and 29% were playing competitive sport. Ninety-three percent of the study sample had attempted sport at some time after their ACL reconstruction surgery. Those who had not attempted their preinjury level of sport by 12 months after surgery were just as likely to have returned to preinjury level by 39 months after surgery as those who had played sport by 12 months (risk ratio, 1.1; 95% confidence interval, 0.76-1.6). Less than 50% of the study sample had returned to playing sport at their preinjury level or returned to participating in competitive sport when surveyed at 2 to 7 years after ACL reconstruction surgery. Return to the preinjury level of sport at 12 months after surgery was not predictive of participation at the preinjury level in the medium term, which suggests that people who return to sport within 12 months may not maintain their sports participation.

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Beliefs and attitudes of members of the American Academy of Orthopaedic Surgeons regarding the treatment of anterior cruciate ligament injury.

Michael Angel, Robert Marx, Menna Jones … (2003)

The purpose of the study was to quantify the amount of agreement among orthopaedic surgeons regarding the natural history of the anterior cruciate ligament (ACL)-deficient knee, surgery, and rehabilitation, and the treatment of these patients. Physician mail survey. Orthopaedic surgeons were randomly selected from the American Academy of Orthopaedic Surgeons (AAOS) directory. Only individuals who treated or referred ACL-insufficient patients for treatment within the past year were asked to complete the 3-page survey. The survey included 25 questions regarding clinical opinion. Clinical agreement was present when 80% or more of the surgeons agreed on the same response option. The total number of surgeons who responded to the survey was 397 (response rate, 54.8%) and the number who had treated or referred ACL-insufficient patients in the past year was 261. Among surgeons who completed the questionnaire, the response rates to the individual questions ranged from 92% to 100%. The mean response rate for all questions was 97.4%. The mean age of the surgeons was 48.4 years, and 35.8% considered their practice to be a subspecialty in sports medicine or knee surgery. For 12 questions (48%), there was clinical disagreement among the surgeons. Surgical volume was associated with clinical opinion for 16 of 25 questions (P < or =.05). Significant variation is seen in clinical opinion and decision-making regarding ACL injuries among members of the AAOS, particularly regarding whether ACL-deficient patients can participate in all recreational sports activities, that ACL reconstruction reduces the rate of arthrosis, and on the use of braces in the postoperative period. Additionally, surgeons disagreed on the effect of 4 patient characteristics (age over 40, presence of pain, irreparable meniscal tear, injury involving Workers' Compensation) on the decision to perform surgery. Areas of significant clinical uncertainty should be the focus of future research and medical education for orthopaedic surgeons who treat ACL injuries.

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Author and article information

Journal

Journal ID (iso-abbrev): Am J Sports Med

Title: The American journal of sports medicine

ISSN (Electronic): 1552-3365

ISSN (Print): 0363-5465

Publication date (Electronic): Jul 2015

Volume: 43

Issue: 7

Affiliations

[1 ] Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA gcbalazs@gmail.com.

[2 ] Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.

[3 ] Naval Health Clinic Annapolis, United States Naval Academy, Annapolis, Maryland, USA.

Article

Publisher Item ID: 0363546514545864

DOI: 10.1177/0363546514545864

PubMed ID: 25164575

SO-VID: 5e8aa3e4-4776-4772-a4db-c68c43a313d3

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Keywords: anterior cruciate ligament injury,football,injury risk,playing surfaces,soccer

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Keywords: anterior cruciate ligament injury, football, injury risk, playing surfaces, soccer

Risk of Anterior Cruciate Ligament Injury in Athletes on Synthetic Playing Surfaces: A Systematic Review.

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Abstract

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REPO4EU WP2 Systematic Reviews

Most cited references 28

Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play.

Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery.

Beliefs and attitudes of members of the American Academy of Orthopaedic Surgeons regarding the treatment of anterior cruciate ligament injury.

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