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Anterior cruciate ligament rupture in field hockey

Anterior cruciate ligament rupture in field hockey?

Sports physiotherapist

Although the knee is the second most frequently injured body part among NCAA(1) players and the third most frequently injured body part among NHL(2) players, anterior cruciate ligament (ACL) injuries are uncommon among field hockey players. In fact, the incidence of this injury is higher in sports requiring rapid changes of direction, pivots and jumps(3). The repercussions of this injury can be devastating, keeping an athlete out of competition for a long time, increasing the risk of osteoarthritis 10-fold, leading to concomitant injuries to both knees and a risk of recurrence following surgery (4,5). Its impact on professional basketball and soccer players has been described in several studies (6,7), but what about field hockey players?

Researchers in Minnesota looked into the matter and tracked NHL players from 2006 to 2010 via the NHL Injury Surveillance System(8). They examined the impact of an ACL injury on performance as well as career length. A total of 47 players suffered a complete ACL rupture during the study period. Of these, 5 players (10.6%) did not return to the game. For those who were able to return, the average time to return to competition was 9.8 months (from 6 to 21 months). What’s more, players with an associated meniscus injury saw their careers cut short, which was not the case for those with an associated medial collateral ligament injury, regardless of the grade of the lesion.

By comparing the players’ productivity in the two seasons before and two seasons after the injury, as well as with a control group, we are able to assess the impact of this injury on performance when a return was possible. The players up front have also seen their production of goals, assists, points and games played decline. This trend is not observed among defenders, who seem to be maintaining similar production levels and have even improved their differential (+/-).

Among professional players, it would appear that the vast majority are able to return to play following ACL surgery (8,9). Poor prognostic factors include concomitant meniscus injury and a forward position. However, we must be cautious in interpreting these results, and not assume that this injury has the same impact on other field hockey players. In the younger age groups, such a long absence from competition can have a huge impact on their development. In fact, it would appear that the risk of re-operation increases the earlier the first operation is performed(13). Hence the importance of making every effort to prevent such injuries.

Fortunately, there are various prevention programs that help reduce the incidence of this injury (10,11,12). The biggest challenge in field hockey is the unpredictable nature of the sport. Unlike other sports, most ACL ruptures occur as a result of contact with the opponent or the boards (8). Hence the importance of adapting the prevention program to the type of sport practised, as well as tailoring interventions to the specific needs of each individual.

Written by Maxime Provencher, M. Physiotherapy

References:
1. Rishiraj N & coll. University men’s ice hockey: rates and risk of injuries over 6-years. J Sports Med Phys Fitness.2009 Jun;49(2):159-66.
2. McKay CD, Tufts RJ, Shaffer B, & coll. The epidemiology of professional ice hockey injuries:a prospective report of six NHL seasons Br J Sports Med 2014;48: 57-62.
3. Griffin LY, Albohm MJ, Arendt EA & al.Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. Am J Sports Med.2006 Sep;34(9):1512-32.
4. Gillquist J, Messner K. Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrosis. Sports Med.1999 Mar;27(3):143-56.
5. Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K.Incidenceandrisk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy. 2005 Aug;21(8):948-57.
6. Harris JD, Erickson BJ, Bach BR Jr & al. Return-to-Sport and Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players. . Sports Health.2013 Nov;5(6):562-8.
7. Shah VM,Andrews JR,Fleisig GS, McMichael CS, Lemak LJ. Return to play after anterior cruciate ligament reconstruction in National Football League athletes. Am J Sports Med. 2010 Nov;38(11):2233-9.
8. Sikka R, Kurtenbach C, Steubs JT & al. Anterior Cruciate Ligament Injuries in Professional Hockey Players. Am J Sports Med.2016 Feb;44(2):378-83.
9. EricksonBJ, Harris JD, Cole BJ & al. Performance and return to sport after anterior cruciate ligament reconstruction in National Hockey League players. Orthop J Sport Med. 2014;2(9)
10. Donnell-Fink LA, Klara K, Collins JE &al. Effectiveness of Knee Injury and Anterior Cruciate Ligament Tear Prevention Programs: A Meta-Analysis. PLoS One. 2015 Dec 4;10(12).
11. Michaelidis M, Koumantakis GA. Effects of knee injury primary prevention programs on anterior cruciate ligament injury rates in female athletes in different sports: a systematic review. Phys Ther Sport. 2014 Aug;15(3):200-10.
12. Sugimoto D, Myer GD, Foss KD, Hewett TE.Dosage effects of neuromuscular training intervention to reduce anterior cruciate ligament injuries in female athletes: meta- and sub-group analyses. Sports Med. 2014 Apr;44(4):551-62
13. Maletis GB, Chen J, Inacio MCS & AL. Age-related factors for revision anterior cruciate ligament reconstruction: A cohort study of 21,304 patients from the kaiser permanente anteriorcruciate ligament registry. Am J Sports Med. 2016; 44 :331

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