Pattern of Anterior Cruciate Ligament Reconstruction (ACLR) among Athletes in Malaysia between 2015 and 2020
DOI:
https://doi.org/10.17309/tmfv.2022.3s.07Keywords:
ACL reconstruction, descriptive epidemiology, pre-operative physiotherapy, knee injuryAbstract
Background. Individual involvement in sports activity is rising and thus increases the risk of knee injury. Anterior Cruciate Ligament (ACL) rupture is the most common knee injury requiring ACL reconstruction (ACLR). However, limited evidence is available to date on ACLR characteristics in Malaysia for comparison with Western countries. This study aims to describe the epidemiological characteristic of ACLR surgery and the trend of pre-operative physiotherapy (pre-habilitation).
Materials and methods. ACLR cases recorded in a tertiary hospital database between January 2015 and December 2020 were extracted and reviewed. This retrospective study was approved by the hospital’s Research Ethics Committee (UKMPPI/111/8/JEP-2020-500). All ACLR cases involving sports injuries were included with the exclusion of non-sports related injuries. Yearly ACLR cases were retrieved using an Injury Information form containing variables namely age, gender, type of ACL tear, accompanying meniscus injury, duration from injury to surgery and pre-habilitation details. Descriptive statistics were used to summarize the sample data.
Results. A total of 131 ACLR cases were reported between 2015 and2020 (Male, n =122; Female, n = 25). The number of ACLR cases fluctuated during the observed years, with a maximum of 30 cases reported in a year and 98% of the cases were represented by the youth age group (15 – 47 years old). The average age at time of surgery was 27.1 (± 7.79). On an average, 80% of athletes stated no history of previous knee injury. The most common type of ACL injury was a complete tear (88%), followed by partial tear (9%), and re-rupture (3%). A meniscus injury was noted in 61% of cases. The time from injury to surgery was 15 weeks. The study found low percentage of the ACLR patients who received pre-habilitation prior to surgery (<20%).
Conclusions. ACLR cases are showing a fluctuating trend every year. Despite the majority of the ACL cases being a complete tear, the participants waited more than four months to undergo ACLR, with only a quarter of them had pre-habilitation prior to surgery. The reasons for these situations require investigation. Future research inclusive of a larger database is also desirable to develop a better insight into ACL injury pattern.
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References
Dhillon, K. (2014). ‘Doc’do I need an anterior cruciate ligament reconstruction? What happens if I do not reconstruct the cruciate ligament? Malaysian orthopaedic journal, 8(3), 42. https://doi.org/10.5704/moj.1411.010
Rothrauff, B. B., Jorge, A., de Sa, D., Kay, J., Fu, F. H., & Musahl, V. (2020). Anatomic ACL reconstruction reduces risk of post-traumatic osteoarthritis: a systematic review with minimum 10-year follow-up. Knee Surgery, Sports Traumatology, Arthroscopy, 28(4), 1072-1084. https://doi.org/10.1007/s00167-019-05665-2
Giesche, F., Niederer, D., Banzer, W., & Vogt, L. (2020). Evidence for the effects of prehabilitation before ACL-reconstruction on return to sport-related and self-reported knee function: A systematic review. PLoS One, 15(10), e0240192. https://doi.org/10.1371/journal.pone.0240192
King, E., Richter, C., Jackson, M., Franklyn-Miller, A., Falvey, E., Myer, G. D., Strike, S., Withers, D., & Moran, R. (2020). Factors influencing return to play and second anterior cruciate ligament injury rates in level 1 athletes after primary anterior cruciate ligament reconstruction: 2-year follow-up on 1432 reconstructions at a single center. The American Journal of Sports Medicine, 48(4), 812-824. https://doi.org/10.1177/0363546519900170
Prentice, H. A., Lind, M., Mouton, C., Persson, A., Magnusson, H., Gabr, A., Seil, R., Engebretsen, L., Samuelsson, K., & Karlsson, J. (2018). Patient demographic and surgical characteristics in anterior cruciate ligament reconstruction: a description of registries from six countries. British Journal of Sports Medicine, 52(11), 716-722. https://doi.org/10.1136/bjsports-2017-098674
Tabben, M., Eirale, C., Singh, G., Al-Kuwari, A., Ekstrand, J., Chalabi, H., Bahr, R., & Chamari, K. (2022). Injury and illness epidemiology in professional Asian football: lower general incidence and burden but higher ACL and hamstring injury burden compared with Europe. British Journal of Sports Medicine, 56(1), 18-23. https://doi.org/10.1136/bjsports-2020-102945
Costa, L. A., Foni, N. O., Antonioli, E., Teixeira de Carvalho, R., Paião, I. D., Lenza, M., & Ferretti, M. (2018). Analysis of 500 anterior cruciate ligament reconstructions from a private institutional register. PLoS One, 13(1), e0191414. https://doi.org/10.1371/journal.pone.0191414
Mall, N. A., Chalmers, P. N., Moric, M., Tanaka, M. J., Cole, B. J., Bach Jr, B. R., & Paletta Jr, G. A. (2014). Incidence and trends of anterior cruciate ligament reconstruction in the United States. The American Journal of Sports Medicine, 42(10), 2363-2370. https://doi.org/10.1177/0363546514542796
Sanders, T. L., Maradit Kremers, H., Bryan, A. J., Larson, D. R., Dahm, D. L., Levy, B. A., Stuart, M. J., & Krych, A. J. (2016). Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. The American Journal of Sports Medicine, 44(6), 1502-1507. https://doi.org/10.1177/0363546516629944
Church, S., & Keating, J. (2005). Reconstruction of the anterior cruciate ligament: timing of surgery and the incidence of meniscal tears and degenerative change. The Journal of bone and joint surgery. British volume, 87(12), 1639-1642. https://doi.org/10.1302/0301-620x.87b12.16916
Spahn, G., Schiltenwolf, M., Hartmann, B., Grifka, J., Hofmann, G., & Klemm, H. (2016). The time-related risk for knee osteoarthritis after ACL injury. Results from a systematic review. Der Orthopade, 45(1), 81-90. https://doi.org/10.1007/s00132-015-3170-4
Sonnery-Cottet, B., Praz, C., Rosenstiel, N., Blakeney, W. G., Ouanezar, H., Kandhari, V., Vieira, T. D., & Saithna, A. (2018). Epidemiological evaluation of meniscal ramp lesions in 3214 anterior cruciate ligament–injured knees from the SANTI study group database: a risk factor analysis and study of secondary meniscectomy rates following 769 ramp repairs. The American Journal of Sports Medicine, 46(13), 3189-3197. https://doi.org/10.1177/0363546518800717
Fabricant, P. D., Lakomkin, N., Cruz Jr, A. I., Spitzer, E., & Marx, R. G. (2016). ACL reconstruction in youth athletes results in an improved rate of return to athletic activity when compared with non-operative treatment: a systematic review of the literature. Journal of ISAKOS, 1(2), 62-69. https://doi.org/10.1136/jisakos-2015-000013
Vermeijden, H. D., Yang, X. A., Rademakers, M. V., Kerkhoffs, G. M., van der List, J. P., & DiFelice, G. S. (2022). Early and Delayed Surgery for Isolated ACL and Multiligamentous Knee Injuries Have Equivalent Results: A Systematic Review and Meta-analysis. The American Journal of Sports Medicine, 03635465211069356. https://doi.org/10.1177/03635465211069356
Kennedy, J., Jackson, M., O’kelly, P., & Moran, R. (2010). Timing of reconstruction of the anterior cruciate ligament in athletes and the incidence of secondary pathology within the knee. The Journal of bone and joint surgery. British volume, 92(3), 362-366. https://doi.org/10.1302/0301-620x.92b3.22424
Bieri, K. S., Scholz, S. M., Kohl, S., Aghayev, E., & Staub, L. P. (2017). Dynamic intraligamentary stabilization versus conventional ACL reconstruction: a matched study on return to work. Injury, 48(6), 1243-1248. https://doi.org/10.1016/j.injury.2017.03.004
Yeo, D. Y., Suhaimi, F., & Parker, D. A. (2019). Factors predicting failure rates and patient-reported outcome measures after arthroscopic meniscal repair. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 35(11), 3146-3164. e3142. https://doi.org/10.1016/j.arthro.2019.06.016
Grindem, H., Risberg, M., & Eitzen, I. (2015). Two factors that may underpin outstanding outcomes after ACL rehabilitation. In (Vol. 49, pp. 1425-1425): BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine. https://doi.org/10.1136/bjsports-2015-095194
von Essen, C., Eriksson, K., & Barenius, B. (2020). Acute ACL reconstruction shows superior clinical results and can be performed safely without an increased risk of developing arthrofibrosis. Knee Surgery, Sports Traumatology, Arthroscopy, 28(7), 2036-2043. https://doi.org/10.1007/s00167-019-05722-w
Gränicher, P., & Scherr, J. (2021). Do athletes benefit from preoperative physical therapy before ACL-reconstruction? Sports Orthopaedics and Traumatology, 37(2), 126-131. https://doi.org/10.1016/j.orthtr.2021.04.038
Carter, H. M., Webster, K. E., & Smith, B. E. (2021). Current preoperative physiotherapy management strategies for patients awaiting Anterior Cruciate Ligament Reconstruction (ACLR): A worldwide survey of physiotherapy practice. The Knee, 28, 300-310. https://doi.org/10.1016/j.knee.2020.12.018
Wilk, K. E., & Arrigo, C. A. (2016). Preoperative phase in the rehabilitation of the patient undergoing anterior cruciate ligament reconstruction. Operative Techniques in Sports Medicine, 24(1), 12-20. https://doi.org/10.1053/j.otsm.2015.10.003
Ebrahimi Atri, A., & Taghizadeh, M. (2021). The Effect of Prehabilitation on the Self-Reported Outcomes of Anterior Cruciate Ligament Reconstruction: A Systematic Review. Iranian Journal of Health Sciences, 9(1), 45-55. https://doi.org/10.18502/jhs.v9i1.5972
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