Hello. I'm Mike Battaglia from Seattle, Washington. I wanted to thank my co-authors, the team at Steadman Clinic, particularly Dr. Prevencher, who always makes it happen. He's got on his maroon coat today. And also the treating doctor, who all these patients came from, Pierpaolo Mariani, and all the patients were treated at Villa Stewart, which is a private hospital in Rome. And it's not working. The only author who has some disclosures is Dr. Prevencher. Didn't impact the study at all. So what's known about this topic is that, of course, higher activity level leads to greater risk of ACL graft failure, but there's also many other factors that are at play. Graft maturation, we know, takes up to 24 months. We looked at some MRI studies, and also recently published data from Europe shows that the younger patient population, those that go back to sport earlier than nine months, have about a seven times greater incidence of failure. But there's other factors that need to be considered, proprioception strength, isokinetic strength, psychological readiness, and also other motivating factors to return to sport. So what motivates these professional soccer players, out of this group of 180, to get back to sport quicker? Well, avoid losing their position, declining condition level and skill. They can get traded, and of course, loss of income. This is just some of the kind of sport-specific things that they're doing afterwards. So what benefits these athletes? Obviously, you're starting off with professional athletes that have better protoplasm, greater neuromuscular control and strength. They have greater access to recovery resources. Ninety-eight percent of the patients in the study population were not from Rome, Italy. They were from France, Germany, England. So they basically stay there for about four weeks in Rome. They go to physical therapy at Bill Stewart twice a day. And of course, they're more incentivized to follow the rehab protocol because they want to get back to sport. However, of course, in sports, particularly soccer, I think, because of the high level of cutting and non-contact injuries, they're at high risk of failing. So our purpose was, retrospectively, we arbitrarily picked six months of early return to play versus a longer than six months or standard return to play in professional European soccer players. The hypothesis being that those that return early would fare worse in terms of increased risk of failure, lower volume of play, and would play fewer seasons in their professional career following that intervention than the other group. So inclusion criteria, of course, professional soccer players, male players, they were all either Serie A, Champions League, or Germany, France. And they had ACL injuries, excluded multiligament knee injuries requiring reconstruction. There were several patients that had repair of MCLs. And then contralateral prior ACL or ligamentous knee injury. So data points collected were, of course, their position, players club, and league level at the time of injury. All operative reports were reviewed to include medial and meniscal tears, articular cartilage, lesions, fractures, capsular ligamentous injuries, et cetera. And then the primary thing we looked at, of course, was time from intervention or surgery to their first official game, which was very easily found on the internet and verified by the team at Stedman after I initially found those dates. Most of these surgeries were done very rapidly after the initial injury, so about five days at most for almost all of them. So we recorded their ability to return to play in the same season, number of games played, total on average, minutes played when they returned. Next slide, please. So this is just some pictures of one of the patients a day or two after his surgery doing some of the rehab and you can advance it. So basically closed chain, open chain exercises, gait, and then progress towards sport specific exercises. Advance, please. This is actually the day after surgery. And advance. Advance. Next slide, please. And you can advance through this, too. This is just sports specific training that they're doing. This is when they're back at their club, so as I noted, most of the players went back to their home teams within about four weeks or so. Advance. So this kind of summarizes the findings of the study. Mean return to play in the standard group, 9.2 months. Early return to play, 4.76 months. There was no difference really in terms of games played in the return season, nor the amount of minutes that either group played in the return season. The thing that I think is most important that we found here is that the mean seasons played or the professional career, although some are still playing when we took it at the time of the data, was 10 months more in those that went back earlier return to play. 56 patients out of the 92 in the early return to play returned the same season as their injury and surgery, whereas only 18 in the standard return to play returned the same season. There were four failures in the early return to play group, one in the standard return to play group, but it should be noted that the only one less than nine months in the early return to play group was at four months. He was revised by the primary surgeon and is still playing for AC Milan. Next slide, please. So in conclusion, we did have more graft failures in those less than six months. It did reach statistical significance, but the patients that were less than six months returned more often in the same season, played the same number of games and minutes as the other group, and also had longer professional careers. As with any professional sport, it's very important to be an athlete because they have a limited amount of time where they can make money and play their sport. Next slide. And you can advance it. And advance just the pictures of some of the sport-specific training done afterwards. Next slide. That's it. Thank you very much.

return to play timeline

ACL injuries

professional European soccer players

graft failure rates

shorter professional careers