Jan 29, 2015
ACL Studies Take Center Stage

By Patrick Bohn

Recently, a new wave of research on ACL tears and reconstruction techniques has been published in a variety of medical journals and websites. In this blog, we take a look at the most recent findings.
It’s relatively common knowledge that female athletes are more likely to suffer ACL tears than male athletes–anywhere from two to eight times more likely, in fact. And while most of the research as to why this is the case is focused on neuromuscular and anatomic differences between the genders, little attention has been paid to the possibility of genetic differences.

But a new study published this month by the American Academy of Orthopaedic Surgeons (AAOS) that examined biopsies of ruptured ACL tissue from seven male and seven female athlete patients points to the possibility.

The biopsies were divided up for histological and genetic analysis, and researchers discovered 32 significantly differentially expressed genes, 14 of which were then grouped “according to skeletal muscular development, function, and cellular growth.” Researchers discovered “altered responses in signaling pathways that regulate cartilage and tissue growth.”

Regarding reducing the risk of ACL injuries, research presented at the 2014 Annual Meeting of the AAOS showed that having young athletes concentrate on the proper way to bend, jump, land, and pivot the knee is a way to avoid ACL injuries. As an added bonus, neuromuscular training such as this can be a cost-effective way to prevent these injuries.

“According to our model, training was so much less expensive and so much more effective than we anticipated,” lead study author Eric F. Swart, MD, an orthopaedic resident at Columbia University Medical Center in New York, said in a press release. “In addition, fewer players injured means fewer surgical reconstruction procedures, which also saves money.”

Additional research presented at the AAOS conference focused on the possible predictors of recovery from an ACL injury and found that a patient’s age and the type of tissue graft they receive had direct impacts on the outcome of reconstructive ACL surgery. ACL reconstructions from the Multicenter Orthopaedics Outcomes Network were studied over a period of multiple years.

“This is the first time we looked at risk factors and found that with the right combination, athletes can avoid complete failure and future ACL reconstructions post-surgery,” said Kurt Spindler, MD, Vice Chairman of Research at Cleveland Clinic’s Orthopaedic & Rheumatologic Institute.

Finally, according to findings presented at the American Orthopaedic Society for Sports Medicine’s Specialty Day, high-level college football players are overwhelmingly more likely to return to the field following an ACL reconstruction. And players who were starters almost always see action again.

Based on 184 ACL injuries sustained by players in 13 NCAA Division I Football Bowl Subdivision conferences, researchers found that just over 80 percent of players return after ACL surgery. Among players who were starters prior to the injury, that number climbs to 94 percent.

“Our research shows that returning from a major knee injury and surgery is definitely possible. Furthermore, we’ve found that the more motivated and skilled players are more likely to achieve this goal,” said Dr. Jimmy Hoshang Daruwalla from the Emory University Department of Orthopaedics.

Patrick Bohn is an Assistant Editor at Training & Conditioning.

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