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Anterior cruciate ligament injuries result in a larger functional deficit in fighting sport athletes: comparison of functional status among different sport types
  1. Kanehiro Hiyama1,
  2. Yusuke Nakagawa1,
  3. Toshiyuki Ohara1,
  4. Takeshi Muneta2,
  5. Toshifumi Watanabe1,
  6. Masafumi Horie1,
  7. Koji Otabe1,
  8. Hiroki Katagiri1,
  9. Kenta Katagiri1,
  10. Mai Katakura1,
  11. Takashi Hoshino1,
  12. Hiroko Ueki1,
  13. Kei Inomata1,
  14. Naoko Araya1,
  15. Ichiro Sekiya3,
  16. Hideyuki Koga1
  1. 1Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
  2. 2Department of Orthopaedic Surgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
  3. 3Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
  1. Correspondence to Dr Hideyuki Koga, Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo 113-8519, Japan; koga.orj{at}


Objectives To compare the effects of anterior cruciate ligament (ACL) injuries and the preoperative period on functional status in different sports using preoperative patient data from the Multicenter Arthroscopic Knee Surgery (MAKS) study, a multicentre prospective cohort study of patients who underwent ACL reconstructions and meniscal surgeries conducted in 2013.

Methods Of the 1648 patients registered in the MAKS study cohort, 826 underwent unilateral primary ACL reconstruction. These patients were divided into three groups based on sports activity type: contact, fighting and non-contact. The patients were further divided into two subgroups according to preoperative period data: acute (≤3 months) and chronic (>3 months). We standardised the preoperative evaluation items (Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) subjective form, and Lysholm score) and surgical records.

Results The mean Lysholm score in the non-contact group was statistically significantly better than that in the fighting group. The two KOOS subcategories were statistically significantly superior in the non-contact group than in the fighting group. In the contact group, acute cases showed statistically significantly lower IKDC subjective scores and lower scores in two KOOS subcategories than the chronic cases. In the fighting group, chronic cases showed better IKDC subjective scores and scores for three KOOS subcategories than the acute cases. In the non-contact group, chronic cases showed better IKDC subjective scores and scores for all KOOS subcategories than the acute cases.

Conclusion When athletes with ACL injuries are divided by sport type into fighting, contact and non-contact groups, the functional status of fighting sport athletes was more negatively influenced by ACL injury than those of non-contact sport athletes. When divided into acute and chronic phases, overall acute cases showed lower scores than the chronic cases in all sport types. In acute cases, the functional status of fighting sport athletes was more negatively influenced than non-contact sport athletes, whereas in chronic cases, there were no differences among the different sport types. The sport types and postinjury period should be considered for decision-making on therapeutic measures of patients with ACL injuries.

Level of evidence Level II.

  • ACL / PCL
  • meniscus
  • sports medicine research
  • sport-specific injuries
  • knee

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  • Contributors Conception and design of study: HK, KH, YN, TM. Acquisition of data: TO, KK, HU, KI, NA. Analysis and/or interpretation of data: TW, MH, KO, HK, IS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Institutional Review Board of Tokyo Medical and Dental University (research protocol identification number: 1547)

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

  • Collaborators We appreciate contributing authors for their efforts. Kawaguchikogyo General Hospital: Akiho Hoshino, MD, PhD; Takashi Ogiuchi MD, PhD; Hideya Yoshimura, MD, PhD; Masaya Hayashi, MD, PhD; Toru Takahashi, MD, PhD; Katsuaki Yanagisawa, MD, PhD; Mio Udo, MD, PhD. Doai Memorial Hospital: Tsuyoshi Nagase, MD, PhD; Tadanori Shimizu, MD, PhD; Ryusuke Saito, MD, PhD. Yokohama Minato Red Cross Hospital: Koji Asano, MD, PhD; Shinpei Kondo, MD, PhD. Tama-hokubu medical center: Jyu Neishin, MD, PhD. Nitobe Memorial Nakano General Hospital: Jun Kitahama, MD. Suwa Central Hospital: Shinichi Shirasawa, MD, PhD. Nissan Tamagawa Hospital: Tomoyuki Mochizuki, MD, PhD. National Hospital Organization Disaster Medical Center: Masayuki Shimaya, MD, PhD. Mishima General Hospital: Mika Yamaga, MD, PhD. Tsuchiura Kyodo General Hospital: Daisuke Hatsushika, MD, PhD. Soka City Hospital: Arata Yuki, MD, PhD. Tokyo Bay Urayasu Ichikawa Medical Center: Enichi Nakatsuru, MD. Nerima General Hospital: Shingo Fukagawa, MD, PhD.

  • Correction notice This article has been corrected since it was published Online First. A Collaborator statement has been included.

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