Does Sport Affect Concomitant Injury in Patients with ACL Rupture?

Background: Anterior cruciate ligament (ACL) tears make up approximately one-third of all sport-related injuries in high school athletes and frequently do not occur in isolation. While the risk of concomitant injury patterns as a function of specific sports has been studied in adults, this has not been examined in pediatric and adolescent patients. We examined concomitant injury patterns in patients undergoing an ACL reconstruction (ACLR). We sought to determine if certain sports were associated with a higher risk of concomitant injuries.

Methods: This is a retrospective cohort study; level of evidence 3. Patients from two tertiary children’s hospitals who had undergone primary ACLR from 2006-2018 were included. Sport at the time of injury, demographic factors (gender, age, body mass index (BMI), and ethnicity), and injury pattern (isolated ACL, medial meniscus, lateral meniscus, PCL, MCL, and LCL) were identified. Risk ratios adjusted for age, gender, and BMI were calculated for the association of sport with injury type.

Results: There were 855 patients who met inclusion criteria. Of the included patients, 44.8% were female (n=439), mean age (+/- SD) was 15.5 (+/- 1.7), and mean BMI was 24.4 (+/- 4.5). The most common sport associated with ACL tears was basketball (n=224, 26.2%), followed by soccer (n=199, 23.2%), football (n=165, 19.3%), and lacrosse (n=30, 0.035%). Of the included patients, 41.3% had an isolated ACL tear (n=353). A concomitant medial meniscus tear was identified in 27.6% of patients (n=236), lateral meniscus tear in 42.9% (n=367), PCL rupture in 0.4% (n=3), MCL sprain in 3.0% (n=26), and LCL sprain in 0.5% (n=5). Soccer injuries were 1.18 times more likely to result in isolated ACL tears (95% Confidence Interval [CI], 1.00-1.39) compared to basketball. Football demonstrated no association with medial meniscus (adjusted relative risk [ARR], 0.89; 95% CI, 0.69-1.29), lateral meniscus (ARR, 0.97; 95% CI, 0.77-1.23), or isolated ACL (ARR, 1.00; 95% CI, 0.84-1.18) injuries compared to basketball.

Conclusion: Patients playing soccer at the time of ACL rupture had a higher risk of isolated ACL injury compared to patients playing basketball. Relative to basketball, football was not associated with an increased risk of medial meniscus, lateral meniscus, or isolated ACL injuries. This study and future work can aid in understanding sport-associated ACL injury patterns and the prevention of such injuries.