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Accelerated return to sport after anterior cruciate ligament injury: a risk factor for early knee osteoarthritis?
  1. Adam G Culvenor1,2,
  2. Kay M Crossley2
  1. 1Paracelsus Medical University, Institute of Anatomy Salzburg & Nuremburg, Salzburg, Austria
  2. 2La Trobe University, School of Allied Health, Bundoora, Victoria, Australia
  1. Correspondence to Professor Kay M Crossley, School of Allied Health, La Trobe University, Melbourne, VIC 3086, Australia; k.crossley{at}

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Returning to preinjury level of sports participation is a primary goal of anterior cruciate ligament reconstruction (ACLR). Indeed, surgical success is often judged on return-to-sport rates. While timeframes of 6–12 months postsurgery are typically expected, in reality, fewer than two-thirds of individuals return-to-sport within the first year post-ACLR.1 Conservatively managed individuals have similar clinical outcomes—future knee function relies on optimal rehabilitation, irrespective of surgery.2 Although consensus for the most effective rehabilitation approach is lacking, contemporary treatment programmes worship at the altar of accelerated return-to-sport.

Although the finish line for ACL rehabilitation is often defined as resuming sporting pursuits, consequences of ACL injury, including the high reinjury and contralateral injury risk, extend for many years, possibly a lifetime. Radiographic knee osteoarthritis (OA) is inevitable for 50–60% of individuals ≥10 years post-ACL injury and reconstruction.3 Given that typical ACL injured patients are young, this early-onset OA often engenders considerable morbidity and impact on healthcare resources. Could our short-sighted fixation on a fast-tracked return-to-sport be linked to these alarming premature OA rates?

Post-traumatic …

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  • Contributors Both authors designed the study. AGC drafted the manuscript. KMC revised the manuscript for important intellectual content. Both authors approved the final version for publication.

  • Funding AGC is supported by a European Union Seventh Framework Programme (FP7-PEOPLE-2013-ITN; KNEEMO) under grant agreement number 607510. The funding source had no involvement in any aspect of this editorial.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.