Date of Award

2023

Degree Name

Master of Surgery (School of Medicine)

Schools and Centres

Medicine

First Supervisor

Adjunct Associate Professor Lucy Salmon

Second Supervisor

Professor Leo Pinczewski

Third Supervisor

Associate Professor Rustin Roe

Abstract

Background: Netball is a popular sport worldwide, particularly in females. The nature of the sport makes it high-risk for anterior cruciate ligament (ACL) injury.

Purpose: The primary outcome was to determine the prevalence of ACL graft rupture and contralateral ACL (CACL) rupture in Australian female netballers following ACL Reconstruction (ACLR). Additionally, this study aimed to determine the rate of return to sport and psychological readiness.

Study Design: Cross-Sectional Study

Methods: From a prospective database, 332 consecutive ACLR with hamstring autograft conducted between the years 2007-2015 performed by 2 surgeons in female netball players were identified. Patients were retrospectively surveyed at a minimum 5 years after ACLR, including details of second ACL injury to either knee, return to sport and psychological readiness per the ACL Return to Sport after Injury (ACL-RSI) score. Multivariate regression was used to assess the association between selected variables and repeat ACL injury.

Results: 267 (80%) were reviewed at a mean of 8.4 years from ACLR (range 5-15 years). ACL graft rupture occurred in 11 (4%) and contralateral ACL rupture occurred in 27 (10%) at 7 years. ACL graft survival was 99%, 97%, 97 and 96% at 1, 2, 5 and 7 years after surgery respectively. The native CACL had a survival of 100%, 99%, 94% and 90% at 1, 2, 5 and 7 years respectively. Adolescents (aged <20 >years) had a 4.5 times greater hazard for ACL graft rupture (95% CI 1.4-14.6, p-0.014) and 2.5 times greater hazard for contralateral ACL rupture (95% CI 1.2-5.5, p=0.021), compared to adults. CACL injury was also associated with a return to netball (HR 10.3, 95%CI 1.4-77, p=0.023). 62% of participants returned back to netball by 7 years post-operatively, with those with greater ACL-RSI scores more likely to return. Conclusion: The prevalence of repeat ACL injury was higher in the contralateral knee (10%) than the ACL reconstructed knee (4%) at 7 years after ACLR. ACLR is a suitable option for female netballers who sustain an ACL rupture, with low long-term rates of graft rupture. Repeat ACL injuries to either knee were more common in adolescents and those who return to netball.

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