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Effect of a Concussion on Anterior Cruciate Ligament Injury Risk in a General Population

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Abstract

Background

Recent studies indicate concussion increases risk of musculoskeletal injury in specific groups of patients. The purpose of this study was to determine the odds of anterior cruciate ligament (ACL) injury after concussion in a population-based cohort.

Methods

International Classification of Diseases, 9th and 10th Revision (ICD-9, ICD-10) codes relevant to the diagnosis and treatment of a concussion and ACL tear were utilized to search the Rochester Epidemiology Project (REP) between 2000 and 2017. A total of 1653 unique patients with acute, isolated ACL tears were identified. Medical records for cases were reviewed to confirm ACL tear diagnosis and to determine history of concussion within 3 years prior to the ACL injury. Cases were matched by age, sex, and REP availability date to patients without an ACL tear (1:3 match), resulting in 4959 controls. The medical records of the matched control patients were reviewed to determine history of concussion.

Results

39 patients with a concussion suffered an ACL injury up to 3 years after the concussion. The rate of prior concussion was higher in ACL-injured cases (2.4%) compared to matched controls with no ACL injury (1.5%). This corresponds to an odds ratio of 1.6 (95% CI 1.1–2.4; p = 0.015).

Conclusions

Although activity level could not be assessed, there are increased odds of ACL injury after concussion in a general population. Based on the evidence of increased odds of musculoskeletal injury after concussion, standard clinical assessments should consider concussion symptom resolution as well as assessment of neuromuscular factors associated with risk of injuries.

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Author information

Authors and Affiliations

  1. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA

    April L. McPherson

  2. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    April L. McPherson, Matthew B. Shirley & Nathan D. Schilaty

  3. Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA

    Nathan D. Schilaty

  4. Sports Medicine Center, Mayo Clinic, Rochester, MN, USA

    Nathan D. Schilaty

  5. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

    Dirk R. Larson

  6. Department of Rehabilitation Sciences, University of Kentucky, Lexington, KY, USA

    Timothy E. Hewett

Authors
  1. April L. McPherson
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  2. Matthew B. Shirley
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  3. Nathan D. Schilaty
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Corresponding author

Correspondence to Nathan D. Schilaty.

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Funding

Fellowship funding was provided by the Mayo Clinic Graduate School of Biomedical Sciences [ALM]. Funding for this research was received from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR55563 [TEH] and L30AR070273 [NDS]) and the National Institute of Children and Human Development (K12HD065987 [NDS]). This study was also made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award R01AG034676.

Conflict of interest

All authors have no conflicts of interest to declare.

Ethical approval

Institutional review board approval was obtained from both the Mayo Clinic (IRB# 18-001196) and the Olmsted Medical Center (005-OMC-18) and the study complied with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with human participants performed by any of the authors. All patients provided general research authorization for use of their medical records at the time of medical care.

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McPherson, A.L., Shirley, M.B., Schilaty, N.D. et al. Effect of a Concussion on Anterior Cruciate Ligament Injury Risk in a General Population. Sports Med 50, 1203–1210 (2020). https://doi.org/10.1007/s40279-020-01262-3

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