The Challenges of Treating Female Soccer Players With ACL Injuries: Hamstring Versus Bone-Patellar Tendon-Bone...

Area of Science:

• Orthopedic surgery
• Sports medicine
• Biomedical engineering

Background:

• Anterior cruciate ligament (ACL) injuries are prevalent in female soccer.
• Optimal graft selection for ACL reconstruction in this demographic remains unclear.

Purpose of the Study:

• To compare outcomes of ACL reconstruction using hamstring tendon autograft versus bone-patellar tendon-bone (BTB) autograft in female soccer players.
• To evaluate clinical outcomes, return to sport rates, and retear rates between the two graft types.

Main Methods:

• Retrospective review of skeletally mature female soccer players undergoing primary ACL reconstruction (2013-2016).
• Data collected included demographics, injury details, and surgical variables.
• Outcome measures: Lysholm score, Single Assessment Numeric Evaluation, Tegner score, visual analog scales, and return to sport assessment.

Main Results:

• 90 players included; 79% followed for ≥2 years or until graft failure.
• The BTB group had lower BMI and shorter follow-up.
• No significant differences in clinical outcome scores or retear rates between hamstring and BTB grafts.
• BTB group had a higher Tegner activity score (P=.004).
• Fear of re-injury prevented 44.7% from returning to soccer.
• 31.9% of those returning to soccer sustained a subsequent ACL injury.

Conclusions:

• ACL reconstruction in adolescent female soccer players yields high satisfaction regardless of graft choice (hamstring vs. BTB).
• Counseling is crucial: less than half return to pre-injury sport levels.
• High risk of further ACL injury exists upon attempting return to sport.