Summary
ACL injury can now be viewed as a public health issue that has significant consequences to morbidity and now longevity.
Abstract
Claudius Galen surgeon, philosopher and physiologist and the first sports doctor to emperor Marcus Aurelius and the gladiators in 150 AD, claimed that athletes “live shorter and they get arthritis”. 2023 data from Project play of the Aspen institute reveal 26% increase ACL injuries in the young school age athlete. In addition to the 9 to 12 months of convalescence for return to play the PlaySpan (amplitude of participation x time) has been found to be significantly reduced. Falstrom also demonstrated that at 2 years after ACLR young female soccer players quit soccer at a rate of 62% vs 36% control group with a 5X greater rate of ACL injury to either knee. Moreover, return to play after ACLR was 95% in English Premier League (EPL) and Major League Soccer (MLS) but careers were shortened by 1.6 years and 1.3 years respectively. In addition, WNBA and NBA players were found to have a significantly reduced total careers with less games and training hours. Furthermore, young male and female soccer players were found to have significant osteoarthritis in their thirties at 12 and 14 years after ACL injury and reconstruction. In addition, Liukkonen defined a 40% prevalence of osteoarthritis after 20 years whether it was treated operatively or non-operatively. Mendy in cohort-based population study found the risk of cardiovascular death in patients with osteoarthritis was increased OR by 1.43 X and if diagnosis was before age 40 increased to 1.53 X. The ACL injury “syndrome” appears to be a continuum of reduced PlaySpan with a high prevalence of osteoarthritis associated with a greater probability of death by cardiovascular disease. Therefore, ACL injury can now be viewed as a public health issue that has significant manifestations and consequences to morbidity and now longevity. Consequently, to optimize care of the athlete current and future interventions must be focused on:
1. implementation of ACL Prevention programs that prevent most injuries and re-injuries and reduce the prevalence of cartilage injuries.
2. Epigenetic interventions through optimizing Sirtuin survivability genes such as hormesis, nutritional interventions and specific exercise programs that may optimize chondrocyte viability and joint performance.
3. Orthobiologic anabolic strategies to impact onset and progression of osteoarthritis.