ACL tears are one of the most common sports injuries with over 100,000 ACL surgeries performed each year. In a given sport, females remain at a higher risk of injury than their male peers secondary to both non modifiable and non modifiable risk factors. Although Physical Therapy and conservative care have shown equivalent outcomes to surgery at 2 and 5 year follow up, surgery remains the most common treatment pathway for this injury. Authors have reported up to 25% of athletes will re injure ACL graft and many will sustain an ACL injury in the opposite knee. On a positive note, athletes are 7 times less likely to re injury their knee if they extend their Physical Therapy period up to a year before resuming unrestricted or pre injury sports participation. Unfortunately, recent research documents a less than optimal recovery for youth and adolescent patients who sustain a 2nd ACL injury.

The Journal of Pediatric Orthopedics recently published a long term follow up study on 88 patients (50% female, average age 17 years) who underwent a 2nd ACL reconstruction surgery (Christino et al. 2020). On average these athletes sustained a second ACL tear 16 months after their first surgery and underwent their second surgery 2 months later. Surgeons reported additional surgical procedures were required in 25% of these patients. Interestingly, about 1 in 5 sustained an injury in their opposite knee and this percentage increased to 1 in 3 if they injured their original graft. Unfortunately, the return to sport rate dropped significantly after their 2nd ACL surgery with only 69% and 50% of patients returning to some level or previous levels of sport, respectively. These significant statistics reflect a need for a longer post operative recovery period including sport specific training, as well as, more stringent return to sport criteria after an initial ACL injury.

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