Clinical, functional, and radiologic outcome in team handball players 6 to 11 years after anterior cruciate ligament injury: a follow-up study

BACKGROUND: Long-term outcome after anterior cruciate ligament injury among top-level pivoting athletes is unknown. PURPOSE: To evaluate outcome among competitive team handball players after anterior cruciate ligament injury. STUDY DESIGN: Prospective cohort study. METHODS: A previously studied group of 86 elite players who had an anterior cruciate ligament rupture were invited to participate in follow-up evaluations a mean of 7.8 years later. RESULTS: Among the 57 operatively treated patients who returned for follow-up, 33 (58%) returned to team handball at their preinjury level, compared with 18 of 22 (82%) in the nonoperative group. Eleven of the 50 players (22%) who continued playing reinjured their anterior cruciate ligament when playing team handball. The overall Lysholm score was 85 +/- 13 in both groups, but the five players classified as poor were all operatively treated. Nearly half of the players had an International Knee Documentation Committee classification of abnormal or severely abnormal. There were significant differences between the injured and uninjured leg in functional (2.5% to 8%), strength (3.8% to 10.1%), and KT-1000 arthrometer tests (27%). In the operatively treated group, 11 developed radiologic gonarthrosis, compared with 6 in the nonoperatively treated group. There was no correlation between radiologic findings and pain scores. CONCLUSION: A more restrictive attitude regarding return to competitive pivoting sports after anterior cruciate ligament injury may be warranted.