Risk of Future Injury after ACL Surgery

In our experience, a sub group of patients who have successfully returned to sports after an ACL injury continue to be at risk for future injury.  Physical Therapy interventions can significantly reduce the risk of future injury to either an athlete's involved or uninvolved leg.  Athletes who complete their prescribed Physical Therapy visits have both the lowest risk and the best chance  to develop the strength, balance, power, and sport specific movements needed to return to the field, court, or ski slopes.  An important area in our Physical Therapy practice and research is to identify these individuals who remain at risk for future injury.     

Prior research reports between 3 and 25% of athletes will re rupture their ACL graft after a return to activity (Dodwell et al. 2014).  New research is helping identify these at risk individuals by following athletes after their return to sports.  A recent review article of 19 studies showed a pooled re injury rate of 15% (7 and 8% for the involved and uninvolved knee, respectively) but this rate reached 23% in athletes under 25 years old (Wiggins et al. American Journal of Sports Medicine, 2016).  The majority of these injuries occurred in the early return to play period highlighting the importance of continued sport specific rehabilitation and Physical Therapy as they return to competitive practice and play.  Overall, an athlete who returns to sport after ACL reconstruction has a 30-40 times greater risk of ACL injury vs. their un injured peers.  

Given 1 in 4 athletes will re injure their ACL after returning to sports Physical Therapists should maintain strict return to play criteria with younger athletes.