From ACL Reconstruction to Osteoarthritis: The Role of Return-to-Sport Timing, Graft Type, and Associated Injuries Across Age Groups

Faculty Mentor

Jessica Tolley-McLendon

Location

Savannah Ballroom

Type of Research

Completed

Session Format

Poster Presentation

College

Medical College of Georgia - Savannah Campus

Department

Medical Sciences

Abstract

Background: Anterior cruciate ligament (ACL) injuries are among the most common knee injuries in athletes participating in pivoting sports. While ACL reconstruction (ACLR) restores knee stability and allows return to sport (RTS), many patients develop post-traumatic osteoarthritis (OA) later in life. Identifying modifiable surgical and rehabilitation factors that contribute to OA development remains an important clinical goal. The purpose of this study is to examine how return-to-sport timing, graft type, and concomitant knee injuries following ACL reconstruction influence the long-term risk of osteoarthritis across different age groups. Methods: A structured literature review was conducted using PubMed and Google Scholar to evaluate factors associated with osteoarthritis development following ACL reconstruction. Search terms included ACL injury, ACL reconstruction, return-to-sport, osteoarthritis, graft type, and concomitant injuries. Studies published between 2010 and 2025 involving adolescent and adult populations were included. Twenty-two studies met inclusion criteria, including retrospective cohort studies and meta-analyses. Data were extracted on patient demographics, graft selection, RTS timing, associated injuries, and reported OA outcomes. Results: Earlier return to pivoting sports following ACL reconstruction was associated with higher rates of osteoarthritis during follow-up. Increasing age at the time of reconstruction also correlated with increased OA risk. Graft selection demonstrated variable outcomes, with bone–patellar tendon–bone autografts associated with higher OA incidence compared to hamstring tendon autografts, while quadriceps tendon autografts demonstrated intermediate risk profiles. Concomitant injuries, particularly meniscal and multiligament involvement, increased the risk of OA compared to isolated ACL injuries. Conclusion: Post-traumatic osteoarthritis following ACL reconstruction is influenced by multiple surgical and patient-related factors. Earlier return to sport, graft selection, and associated knee injuries increase OA risk. Improved patient selection, individualized rehabilitation, and optimized return-to-sport criteria may reduce long-term degenerative changes. Understanding how these variables interact can help physicians determine optimal combinations to minimize osteoarthritis development.

Program Description

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Start Date

4-21-2026 1:30 PM

End Date

4-21-2026 3:30 PM

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Apr 21st, 1:30 PM Apr 21st, 3:30 PM

From ACL Reconstruction to Osteoarthritis: The Role of Return-to-Sport Timing, Graft Type, and Associated Injuries Across Age Groups

Savannah Ballroom

Background: Anterior cruciate ligament (ACL) injuries are among the most common knee injuries in athletes participating in pivoting sports. While ACL reconstruction (ACLR) restores knee stability and allows return to sport (RTS), many patients develop post-traumatic osteoarthritis (OA) later in life. Identifying modifiable surgical and rehabilitation factors that contribute to OA development remains an important clinical goal. The purpose of this study is to examine how return-to-sport timing, graft type, and concomitant knee injuries following ACL reconstruction influence the long-term risk of osteoarthritis across different age groups. Methods: A structured literature review was conducted using PubMed and Google Scholar to evaluate factors associated with osteoarthritis development following ACL reconstruction. Search terms included ACL injury, ACL reconstruction, return-to-sport, osteoarthritis, graft type, and concomitant injuries. Studies published between 2010 and 2025 involving adolescent and adult populations were included. Twenty-two studies met inclusion criteria, including retrospective cohort studies and meta-analyses. Data were extracted on patient demographics, graft selection, RTS timing, associated injuries, and reported OA outcomes. Results: Earlier return to pivoting sports following ACL reconstruction was associated with higher rates of osteoarthritis during follow-up. Increasing age at the time of reconstruction also correlated with increased OA risk. Graft selection demonstrated variable outcomes, with bone–patellar tendon–bone autografts associated with higher OA incidence compared to hamstring tendon autografts, while quadriceps tendon autografts demonstrated intermediate risk profiles. Concomitant injuries, particularly meniscal and multiligament involvement, increased the risk of OA compared to isolated ACL injuries. Conclusion: Post-traumatic osteoarthritis following ACL reconstruction is influenced by multiple surgical and patient-related factors. Earlier return to sport, graft selection, and associated knee injuries increase OA risk. Improved patient selection, individualized rehabilitation, and optimized return-to-sport criteria may reduce long-term degenerative changes. Understanding how these variables interact can help physicians determine optimal combinations to minimize osteoarthritis development.