Single Sport Athletes Not Experiencing Increase in Secondary Tear Incidence Despite Earlier Clearance When Compared to Multi-sport Athletes

Background: In response to increased pressure for athletes to pursue sports-specialization at earlier ages, multi-sport participation has been encouraged for protection from over-use injury and diversified athletic development. It is unclear whether participation in multiple sports protects against re-injury. The purpose of this study was to compare functional recovery, psychological recovery, and secondary injury between single- and multi-sport pediatric athletes after primary ACL reconstruction (ACLR).

Methods: Following IRB approval, prospectively collected data on consecutive patients treated for ACL injury (1/2015-2/2018) in a pediatric sports medicine clinic was reviewed. Patients indicated sports participation on a standardized electronic survey, which allowed for categorization as single- or multi-sport athletes. Patients lacking two year follow-up were contacted via phone and questioned on sports participation, return to primary sport, and any secondary injury. Inclusion required primary ACLR within the study window, participation in sport(s) at the time of injury, age <20, a complete Y-balance test 6-9 months after surgery, and at least 2 years post-surgery follow-up. Patients were excluded if they underwent multi-ligamentous reconstruction at the time of surgery, were diagnosed with congenital absence of an ACL, or had bilateral tears prior to surgery. Demographic information, injury characteristics, surgical data, functional clearance data (Y-balance testing), functional and psychological patient reported outcome measures (PROM), return-to-play clearance, and re-injury were reviewed. Categorical variables were compared with a Chi-Square or Fisher’s exact test. Continuous variables were compared with a Mann-Whitney test.

Results: 145 patients met inclusion criteria [age: 14.23 ± 2.09, range: 7-18, 49.66% female]. Single sport athletes comprised 53.79% of the cohort (n=78). Females accounted for 57.69% of single sport athletes, while males accounted for 58.21% of multi-sport athletes (n=45, n=39, p=0.0562). The largest portion (37.18%) of single sport athletes listed soccer as primary sport, while the largest portion (38.81%) of multi-sport athletes listed football as primary sport (n=29, n=26, p=0.0006).

Single sport athletes showed higher scores on Pedi-IKDC prior to surgery (51.62 ± 19.20 vs. 43.73 ± 21.77, p=0.04). Single sport athletes were also cleared fewer days after surgery than multi-sport athletes (271.09 ± 100.08 vs. 313 ± 109.66, p=0.02). Despite single sport athletes obtaining clearance earlier than multi-sport athletes, there was no difference in incidence of secondary ACL injury within 2 years of surgery (p=0.84).

Conclusion: Although single-sport athletes attained clearance in a shorter time than multi-sport athletes, no difference was found in rate of secondary ACL injury within 2-years of follow-up.