Second ACL Injuries in Female Soccer Patients

Scientific Poster P434—on display in Academy Hall C—reports that female soccer players treated with anterior cruciate ligament (ACL) reconstruction who returned to the sport had an increased rate of graft retear and contralateral ACL injury, compared to a similar group of nonsoccer female athletes.

The study involved 180 patients (90 soccer players; 90 nonsoccer players) who had been treated with primary ACL reconstruction between 1998 and 2013. Patients injured during a competitive athletic event were included for further review and followed for an average of 5.8 years postoperatively. Patient outcomes were obtained via Lysholm and International Knee Documentation Committee (IKDC) scores. Soccer players were matched 1:1 to nonsoccer athletes for age, activity level, and graft type.

Overall, 34 percent of female soccer players who returned to soccer had a second ACL tear. Soccer players sustained more second ACL injuries, including both graft failures (11% vs. 1%, P< 0.01) and= contralateral ACL tears (17% vs. 4%, P < 0.01), than nonsoccer players. Of the 67 patients who returned to soccer after ACL reconstruction, significantly more had graft tears (15% vs. 0%, P =0.04), but not more contralateral ACL tears (19% vs. 9%, P =0.34) than those who did not return to soccer. Relatively older age (odds ratio 1.9 per year, P = 0.01) was a significant risk factor for ACL graft tear, but not for contralateral ACL injury. Both groups had similar mean Lysholm and IKDC scores at final follow-up.                          

The authors of P434 “Increased Risk of Second Anterior Cruciate Ligament Injury for Female Soccer Players,” are Melissa M. Allen, MD; Alexander H. King, BS; Michael J. Stuart, MD; Bruce A. Levy, MD; Diane L. Dahm, MD; and Aaron J. Krych, MD.

Details of the authors’ disclosures as submitted to the Orthopaedic Disclosure Program can be found in the Final Program; the most current disclosure information may be accessed electronically at