A high incidence of anterior cruciate ligament (ACL) injuries has been reported in team handball, as well as in other team sports, such as basketball, volleyball, and soccer. There is limited information on whether players are able to come back to their pre-injury sports level after an ACL injury. One potential long-term problem after an ACL injury, whether the treatment is operative or non-operative, is osteoarthritis to the knee. There are so far no studies in team handball looking at the short term (i.e. return to sport) or long-term consequences (i.e. knee function, osteoarthritis and how they are coping with their knees in sport and in their daily life and work) after an ACL injury.
The present study is based on a patient population from a previous study (Myklebust et al 1997). In this study all ACL injuries were prospectively registered in the three upper divisions in Norwegian team handball during the 1989 through 1991 seasons, and a total of 87 ACL injuries were found. Some of them were treated operatively and some non-operatively. These players will be followed up 6-10 years after their initial injury, to examine the consequences of an ACL injury.
The aims of the study are to evaluate:
The return rate to sport at pre-injury level
The number of players with re-injuries after ACL reconstruction
The clinical outcome 6-10 years after injury in the operatively treated group and the non-operatively treated group
The prevalence of radiological changes and their relationship to the clinical outcome
The relationship between clinical outcome and findings at clinical examination
This is a follow-up study of a cohort of team handball players with a previous ACL injury. The ACL injured players from the investigation in 1989-1991 have been invited to take part. We have followed this group 6-10 years after their initial ACL injury.The investigation group consists of 3 persons, two physical therapists (PT) and one physician. The players who lived near Oslo came to Rikshospitalet for tests. The investigation group travelled to three others places in Norway for testing players.
The examination of the players consist of the following tests: questionnaire, KT 1000 arthrometer, clinical examination, muscle performance test, medical journal, IKDC score, Lysholm and Tegner scores, functional knee tests, x- ray.
Fifty-seven players were treated operatively and 22 non-operatively. In the operatively treated group 33 (58%) returned to team handball at their pre-injury level, compared with 18 (82%) in the non-operatively treated group. Eleven (22%) of the 50 players who continued playing re-injured their ACL all when playing team handball. The overall Lysholm score was 85±13, and there was no difference between the treatment groups. The five players classified as poor were all in the operatively treated group. Nearly half of the players were classified as abnormal/severely abnormal in the IKDC evaluation system. We found statistically significant differences between the injured and contralateral leg in functional tests (2.5-8%), strength tests (3.8-10.1%) and KT-1000 (27%). In the operatively treated group 11 (42%) had developed radiological gonarthrosis, compared with 6 (46%) in the non-operatively treated group. There was no correlation between radiological findings and pain scores. These results, particularly the high re-rupture rate, indicate that a more restrictive attitude on the return to competitive pivoting sports may be warranted.