title: Effects of prior knee surgery on subsequent injury, imaging, and surgery in NCAA collegiate athletes.
abstract: BACKGROUND
  High school and professional athletes with a history of orthopaedic surgery have decreased career lengths and are at a greater risk for reinjury compared with their peers. It is unknown whether the same risk applies to intercollegiate athletes.
  
  
  OBJECTIVE
  To determine the effect of prior knee surgery in National Collegiate Athletic Association (NCAA) Division I athletes in the United States.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  Division I athletes who began participation in collegiate athletics at a single institution from fall 2003 to spring 2008 were identified. Athletes with a history of orthopaedic surgery were identified through preparticipation evaluation forms. Data on the number of seasons and games played, number of days missed, diagnostic imaging, athletic injuries sustained, and surgical operations during college were collected through medical records and the Sports Injury Monitoring System (SIMS).
  
  
  RESULTS
  During the 5-year study period, 456 athletes completed preparticipation evaluation forms. Of these, 104 athletes (22.8%) had a history of orthopaedic surgery (Ortho group). Forty-eight (10.5% of all athletes) had a history of knee surgery (Knee group), 16 (3.5%) had a history of anterior cruciate ligament reconstruction (ACL group), and 28 (6.1%) had a history of multiple surgeries (Multiple group). Days missed per season due to any injury and due to knee injury were increased for all surgical groups compared with controls (P < .016). The rate of knee injury and knee surgery while in college was significantly increased for all surgery groups. Athletes in the Knee and ACL groups were 6.8- and 19.6-fold more likely to sustain a knee injury and 14.4- and 892.9-fold more likely to undergo a knee surgery during their collegiate careers compared with controls (P < .001). The number of MRIs per season were 0.83 for the Knee group (P < .001), 1.29 for the ACL (P = .009), and 0.97 for the Multiple group (P < .001), compared with 0.37 for controls. Average career length and percentage of games played were not significantly different between any of the surgery groups compared with controls.
  
  
  CONCLUSIONS
  Athletes who had a history of knee surgery before participation in collegiate athletics miss more days due to injury, have increased rates of knee injury and knee surgery, and require more MRIs during their collegiate careers than their peers.
authors: Sharon L. Hame, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, CHS 76-119, 10833 LeConte Avenue, Los Angeles, CA 90095-6902, USA. shame@mednet.ucla.edu.
authors: Caitlin M
authors: CM
authors: Rugg
authors: Dean
authors: D
authors: Wang
authors: Pamela
authors: P
authors: Sulzicki
authors: Sharon L
authors: SL
authors: Hame
mesh_terms: D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D001265:Athletic Injuries / Q000453:epidemiology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007718:Knee Injuries / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data; D013177:Sports; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014495:Universities; D055815:Young Adult
keywords: anterior cruciate ligament; athlete; collegiate; imaging; knee; prior injury; return; sports; surgery