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Anterior Cruciate Ligament Reconstruction Increases the Risk of Hamstring Strain Injury Across Football Codes in Australia

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Abstract

Objective

The aim of this study was to determine the impacts of anterior cruciate ligament reconstruction (ACLR) and recent (< 12 months) hamstring strain injury (HSI) on (1) future HSI risk, and (2) eccentric knee flexor strength and between-limb imbalance during the Nordic hamstring exercise. A secondary goal was to examine whether eccentric knee flexor strength was a risk factor for future HSI in athletes with prior ACLR and/or HSI.

Methods

In this prospective cohort study, 531 male athletes had preseason eccentric knee flexor strength tests. Injury history was also collected. The main outcome was HSI occurrence in the subsequent competitive season.

Results

Overall, 74 athletes suffered at least one prospective HSI. Compared with control athletes, those with a lifetime history of ACLR and no recent HSI had 2.2 (95% confidence interval [CI] 1.1–4.4; p = 0.029) times greater odds of subsequent HSI while those with at least one HSI in the previous 12 months and no history of ACLR had 3.1 (95% CI 1.8–5.4; p < 0.001) times greater odds for subsequent HSI. Only athletes with a combined history of ACLR and recent HSI had weaker injured limbs (p = 0.001) and larger between-limb imbalances (p < 0.001) than uninjured players. An exploratory decision tree analysis suggested eccentric strength may protect against HSI after ACLR.

Conclusion

ACLR and recent HSI were similarly predictive of future HSI. Lower levels of eccentric knee flexor strength and larger between-limb imbalances were found in athletes with combined histories of ACLR and recent HSI. These findings may have implications for injury rehabilitation.

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Author information

Authors and Affiliations

  1. School of Exercise and Nutrition Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove 4059, Brisbane, QLD, Australia

    Daniel J. Messer & Anthony J. Shield

  2. Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia

    Daniel J. Messer & Anthony J. Shield

  3. School of Health, Sport and Professional Practice, Faculty of Life Sciences and Education, University of South Wales, Wales, UK

    Morgan D. Williams

  4. School of Health Sciences and Social Work, Griffith University, Gold Coast campus, Gold Coast, Australia

    Matthew N. Bourne

  5. Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Gold Coast, Australia

    Matthew N. Bourne

  6. School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia

    David A. Opar & Ryan G. Timmins

  7. Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, VIC, Australia

    David A. Opar & Ryan G. Timmins

Authors
  1. Daniel J. Messer
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  2. Morgan D. Williams
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  4. David A. Opar
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  6. Anthony J. Shield
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Corresponding author

Correspondence to Anthony J. Shield.

Ethics declarations

Funding

No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Anthony Shield is listed as a co-inventor on a patent filed for the knee-flexor testing device employed in this study (PCT/AU2012/001041.2012) as well as being a minority shareholder in the company responsible for comercialising the device. David Opar is listed as a co-inventor on a patent filed for a field-testing device of eccentric hamstring strength (PCT/AU2012/001041.2012) and is a minority shareholder in the company responsible for commercialising the device. Data from prototypes of this device are presented in the current manuscript. David Opar is also the Chair of the Vald Performance Research Committee, a role that is unpaid. He has also received funding from Vald Performance for research unrelated to the current manuscript. His brother and brother-in-law are employees of Vald Performance, and his brother is a minority shareholder in Vald Performance Pty Ltd. Matthew Bourne has previously received funding from VALD Performance for research unrelated to the current project. Morgan Williams is a member of the Vald Performance Research Advisory Committee and has previously received travel and subsistence support from VALD Performance for research unrelated to the current project. Daniel Messer and Ryan Timmins have no conflicts of interest to declare.

Author contributions

DM was involved in the study design, data reanalysis and manuscript write up. AS was involved in the study design and manuscript write up. DO, MB and RT were principal investigators in the three original studies for which AS, DO, RT and MB were involved with recruitment and testing. DO, MB, RT and MW were involved in the study design, and analysis and preparation of this manuscript. All authors had full access to the data in this study and are responsible for the integrity and accuracy of the data analysis.

Transparency declaration

The lead author (DM) is the overall guarantor for this manuscript and affirms that the manuscript is an honest, accurate, and transparent account of the study being reported, that no important aspects of the study have been omitted, and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Ethical clearance

All participants provided written, informed consent for this study, which was approved by the Queensland University of Technology Human Research Ethics Committee and the Australian Catholic University Human Research Ethics Committee. All previous studies were performed in accordance with the standards of ethics outlined in the Declaration of Helsinki.

Patient and public involvement

Patients or the public were not involved in the design, conduct, reporting or dissemination plans of our research.

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Messer, D.J., Williams, M.D., Bourne, M.N. et al. Anterior Cruciate Ligament Reconstruction Increases the Risk of Hamstring Strain Injury Across Football Codes in Australia. Sports Med 52, 923–932 (2022). https://doi.org/10.1007/s40279-021-01567-x

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