The multiyear initiative represents a major activation of the Aspen Institute’s school sports research project with its call to prioritize health and safety. In addition to Aspen Institute and HSS, founding members of the National ACL Injury Coalition include: 

● Players Health – Tyrre Burks, Founder and CEO

● Datalys Center for Sports Injury Research & Prevention – Christy Collins, President

● Centers for Disease Control and Prevention – Kelly Cornett, MS, Health Scientist

● US Youth Soccer – Skip Gilbert, CEO

● Hospital For Special Surgery – Jo A. Hannafin, MD, PhD, Sports Medicine

● New Jersey State Interscholastic Athletic Association – Colleen Maguire, Executive Director

● Cedars-Sinai Kerlan-Jobe Institute – Bert R. Mandelbaum, MD, Sports Medicine

● Emory University – Gregory D. Myer, PhD, FACSM, Sports Performance and Research Center

● National Federation of State High School Associations – Karissa Niehoff, CEO

● Major League Soccer – Holly Silvers-Granelli, PhD, MPT, Director of Research

“At HSS, the leading orthopedic hospital in the world, we are keenly aware that there is an opportunity to prevent approximately 50% of ACL injuries,” said Andrew D. Pearle, Chief of the Sports Medicine Institute at HSS. “Two decades of research and data have allowed us to develop simple training programs that mitigate ACL injury risk. The problem we face now is the implementation of these programs. Convening leading medical, sport, insurance, public health, and educational experts will create the type of coalition we need to develop a bold plan for action and achieve systems-level progress.” 

High rates of ACL injuries among high school athletes can have an adverse effect on sports participation and performance in the near term as well as on overall health and physical activity across the lifespan. Those who suffer ACL injuries are seven times more likely to develop end-stage osteoarthritis that requires knee replacement. The median ACL reconstruction procedure costs $9,400 and total lifetime costs exceed $38,000, with the costs even higher ($88,000) for those who receive non-operative treatment. 

However, not all athletes are at equal risk. Research shows female athletes are 1.5 times more likely to suffer an ACL injury than males. Adolescents playing team sports that require sudden change of direction (cutting, landing, stopping), like soccer, basketball, lacrosse, field hockey, ultimate frisbee, and flag and tackle football, face substantially heightened risk of ACL injuries. Meanwhile, public schools in low-income communities have fewer resources to implement ACL injury prevention programs. Youth from lower-income families are also less likely to have health care insurance as well as access to adequate medical care after an injury. 

A flood of recent ACL injuries in professional women’s soccer highlights the urgency of this public health crisis. Internationally, 57 ACL injuries occurred among the six major women’s professional leagues in 2022. Within the U.S. national team that defends its title in the FIFA Women’s World Cup starting in July, Catarina Macario, Christen Press and Tierna Davidson have suffered an ACL injury in the past six months, while Alex Morgan, Megan Rapinoe, Ashlyn Harris and Ali Kriefer tore the ligament in prior years. 

“If we’re going to build healthy people and communities, we need to reckon with the underappreciated problem of athlete knee injuries that could be prevented,” said Tom Farrey, executive director of the Aspen Institute’s Sports & Society Program. “The problem needs the same attention that has gone to reducing brain injuries, given the importance of healthy knees to moving well and the physical, mental and emotional benefits that flow to those whose bodies stay in motion throughout adulthood.” 

The Aspen Institute is a global nonprofit organization committed to realizing a free, just, and equitable society. Founded in 1949, the Institute drives change through dialogue, leadership, and action to help solve the most important challenges facing the United States and the world. The Aspen Institute Sports & Society Program’s main initiative is Project Play, which develops, applies and shares knowledge that helps build healthy communities through sports. For more information, visit ProjectPlay.us.

Steven Arnoczky, DVM, a veterinary surgeon and renowned scientist started his illustrious career in orthopaedic translational research at HSS over 45 years ago and was the founding Director of the Laboratory for Comparative Orthopaedic Research. Mentored by pioneers in orthopedic research at HSS, John L. Marshall, DVM, MD, Philip D. Wilson, Jr, MD, Russell F. Warren, MD, and Peter A. Torzilli, PhD. Dr. Arnoczky established one of the very first research programs in the U.S. focusing on soft tissues, and he was an early innovator in establishing collaborations between scientists and clinicians. His approach laid the foundation for his transformative research on preserving knee and shoulder joints after injury. Dr. Arnoczky brought the unique combined perspectives of a clinician-scientist, an individual who had a deep understanding of the clinical problems physicians face, and the scientific expertise to design novel laboratory studies to answer these questions. His approach led to many seminal discoveries that have advanced patient care. His research has been recognized by over 30 national and international awards, culminating in his election to the American Orthopaedic Society for Sports Medicine Hall of Fame, the highest honor in sports medicine research. Embodying the HSS philosophy of supporting the next generation of surgeons and scientists, Dr. Arnoczky supported numerous trainees, including HSS faculty, Scott A. Rodeo, MD, sports medicine surgeon and vice chair of Orthopedic Research and co-director of the Orthopedic Soft Tissue Research Program at HSS, and Jo A. Hannafin, MD ,PhD, through mentorship and collaboration as they developed federally funded research programs.

During his tenure at HSS, Dr. Arnoczky met his wife, Brenda, who was head nurse on the neurology/neurosurgery floor at New York Hospital (now New York-Presbyterian Hospital). This gift memorializes the role that HSS played in their lives. “HSS started me on an orthopaedic research career that would change my life. Like so many others whose lives have been enhanced by their time at HSS, Brenda and I are so very grateful for what HSS has meant to us. We are happy to be able to pay it forward with this enduring support,” said Dr. Arnoczky. 

As the No. 1 hospital in orthopedics for 13 straight years by U.S. News & World Report (2022-2023), HSS is a leader in research aimed at improving the lives of patients suffering from debilitating orthopedic and rheumatic conditions such as arthritis, bone and soft tissue injuries, autoimmune diseases, and musculoskeletal pain and deformities.

“This exceptional gift will help to ensure that there is sustained funding for leading-edge investigations taking place at HSS. We are pleased that Steven is building upon his past contributions to HSS as a scientist and mentor to many trainees with this gift, made with his wife, Brenda, to make a lasting difference for HSS and the field of orthopedics,” said Louis A. Shapiro, CEO at HSS.

“HSS is committed to delivering unsurpassed care and improving the field. The Arnoczkys’ gift will help us to continue developing treatments and explore emerging research topics to best improve clinical outcomes as grants will be awarded annually to projects and initiatives aimed at having a clear and measurable impact on patients,” said Dr. Rodeo. 

Through a competitive process, medical students, residents, and fellows collaborating with physicians and scientists on pilot translational orthopedic research projects will be invited to apply for a grant. A selection committee comprising of leading HSS physicians and scientists will evaluate applications. Grants will cover the cost of personnel, equipment, supplies, and other key research resources specific to investigators and their projects.

“We are deeply grateful for Steven and Brenda’s generosity which will enable talented medical students, residents, and fellows to accelerate breakthroughs that change people’s lives,” said Bryan T. Kelly, MD, MBA, president, surgeon-in-chief and medical director at HSS. 

The Arnoczky Endowment for Translational Orthopedic Research will build on HSS’s leadership position as the largest musculoskeletal research facility in the world.

“To see Steven give back to HSS in this way is deeply meaningful to those of us who worked with him early in his career. We join the entire HSS community in thanking the Arnoczkys and celebrating this visionary gift,” said Drs. Warren, Torzilli, and Hannafin, co-founders of the HSS Soft Tissue Research Laboratory.

 The WSMC was a first of its kind focused on women and sports medicine and was co-founded in 1997 by primary sports medicine physician Lisa R. Callahan, MD, and sports medicine surgeon Jo A. Hannafin, MD, PhD, who served as co-directors ever since. The multidisciplinary center now consists of a team of sports medicine-trained clinicians including physicians, nutritionists, exercise physiologists, physical therapists and sports psychologists.

 The change in leadership comes as Dr. Hannafin has recently retired her clinical practice while continuing to be active in the WSMC and as vice chair of the Institutional Review Board at HSS, which is responsible for the evaluation of current and newly submitted research projects. As a practicing physician, Dr. Callahan will also continue to be actively involved in the WSMC while serving in her role as chief medical officer of Madison Square Garden Sports.

 “The WSMC is a key reason why I feel excited to go to work each day. I am constantly inspired by my colleagues and the patient care that they provide, which motivates me to take the very best care of my own patients,” said Dr. Goolsby.

 Approximately 80,000 recreational and elite athletic patients a year receive collaborative care through the WSMC. Every clinician aims to empower each patient to achieve success based on his or her individual goals.

 “Being part of the WSMC has helped me in all facets of life. It’s been invaluable for my career, provided spectacular comradery, and guided me to find a work/life balance,” said Dr. Shubin Stein, who noted how Drs. Callahan’s and Hannafin’s successes have opened so many doors for all women. “They have helped us all to dream big.” 

 Drs. Callahan and Hannafin have led distinguished careers and have served as team physicians for numerous professional and Olympic teams. Notably, Dr. Callahan was the first female head team physician in the National Basketball Association and president of the NBA Physicians Association. Dr. Hannafin was the first female president of the American Orthopaedic Society for Sports Medicine (AOSSM).

“We want to ensure we carry on the legacy and support all of the work that Drs. Callahan and Hannafin have done as true pioneers in our field,” added Dr. Goolsby, who explained that she and Dr. Shubin Stein have spent time individually with all members to determine new, impactful goals for the group.

 WSMC clinicians have provided care for numerous Olympic and professional teams and organizations including the New York Knicks, Westchester Knicks, New York Liberty, TCS New York City Marathon, Champions Series Tennis, USA Basketball, USA Gymnastics, UFC, US Biathlon, US Rowing and US Lacrosse.

 “First and foremost, our priority is patient care. We strive to take care of the whole person, not just their knee or stress fracture. Our biggest advantage is that we have experts across many disciplines who can help keep our patients active through all phases of life,” said Dr. Shubin Stein.

 “I am incredibly proud of the fantastic physicians and surgeons we have recruited over the years as well as the outstanding specialists in physical therapy and sports performance, sports psychology and sports nutrition,” said Dr. Hannafin. “We place a large emphasis on developing and training the next generation of female leaders in sports medicine, so it is truly humbling to see so many of them as team physicians for professional, national and Olympic sports teams.”

 Mentorship formally occurs by training residents and fellows within the HSS Sports Medicine Institute as well as the WSMC summer internship and research assistant programs. Launched in 2000, the summer internship program is highly competitive, with more than 150 applicants each year for three spots.

 Of the more than 200 women mentored by members of the WSMC, 80 percent have pursued a career in medicine, physical therapy, psychology or nutrition. Five women have started sports medicine programs while others have joined the faculty at existing women’s sports medicine programs, fulfilling the critical need to expand expert care to active girls and women everywhere.

“I’m proud of the integrated legacy of care, education and research that has formed a strong foundation for the future of the WSMC,” said Dr. Callahan, who oversees the care of the New York Knicks, New York Rangers, Westchester Knicks and Hartford Wolf Pack. “Drs. Goolsby and Shubin Stein have the experience, knowledge and compassion to lead the next phase of growth and advancement. I look forward to their future accomplishments.”

Current research within the WSMC focuses on a variety of issues that impact women athletes, such as the female athlete triad, anterior cruciate ligament (ACL) injuries, vitamin D and bone health, patellofemoral disorders, frozen shoulder, postpartum care and more.

 According to Dr. Hannafin, there is a need for continued research into gender- and sex-specific issues in injury prevention, sports-specific injuries and response to treatment. Through this research, the WSMC can continue to optimize patient care with specialized treatment for each individual patient.

 “The center’s impact on the national landscape of women’s sports medicine is immeasurable. Their selective and immersive summer internships alone work to shape the future for women in the field,” said Andrew D. Pearle, MD, chief of the HSS Sports Medicine Institute. “We are proud to have them as part of our team.”

The researchers conclude their findings demonstrate a need for further interventions to reduce concussion rates, such as the required use of protective head equipment in women’s sports, the adoption of neck-strengthening exercises and other prevention training, and greater enforcement of rules to decrease levels of contact in men’s sports.

Concussions can occur in a wide range of sports, affecting not only professional athletes but youth athletes as well. There are approximately 1.7 million to 3.8 million sports concussions reported in the nation each year^1,2,3 as well as 1.1 million to 1.9 million pediatric recreation-related concussions.⁴

For the first paper, "Sex-Based Differences in the Incidence of Sports-Related Concussion: Systematic Review and Meta-analysis," first published on September 30, 2019, in the journal Sports Health, senior author Daphne Ling, PhD, MPH, a sports medicine epidemiologist at HSS, and colleagues conducted a meta-analysis of sex-based differences in concussion incidence in lacrosse, soccer, baseball/softball, basketball, track and field and swimming/diving. They found that the concussion incidence rates for females were statistically significantly higher compared to males in both soccer and basketball.

“While the causes are unknown, we suspect this sex difference in concussion incidence in soccer and basketball might be attributed to females having decreased head and neck strength, greater peak angular acceleration and increased angular displacement compared to males. Female athletes are also more likely to disclose their symptoms to coaches and parents. This is important for physicians to consider when treating patients who participate in these sports,” concluded Dr. Ling.

For the second paper, "Women Are at Risk for Concussions Due to Ball or Equipment Contact in Soccer and Lacrosse," published online ahead of print on October 17, 2019, in the journal Clinical Orthopaedics and Related Research (CORR), senior author Ellen Casey, MD, a sports medicine physician with the Women’s Sports Medicine Center at HSS, and colleagues conducted a meta-analysis of 10 studies published from January 2000 to December 2018. The studies reported concussion incidence for both male and female athletes who participated in the following sports: ice hockey, soccer, basketball, baseball/softball and lacrosse. The objective was to identify in which sports female athletes were less likely to experience concussions from player contact versus ball or equipment contact.

In female athletes, the main cause of concussions was contact with the ball or equipment in lacrosse, and heading the ball in soccer. Additionally, female hockey players were more likely than male players to experience concussions after contact with the ice surface. The researchers found no differences between male baseball and female softball players for ball/equipment-induced concussions. Similarly, there was no difference observed between male and female basketball players for surface or ball contact.

Furthermore, the pattern of the underlying concussion-causing mechanism was the same regardless of differences between the male and female versions of the sport. It is suggested that sex hormones; decreased neck strength in female athletes, which reduces their ability to withstand external forces; and increased neck and torso strength in male athletes, which allows them to better absorb impact in the upper body versus in the head alone, may play a role in the sex differences in concussion incidence.

To reduce their risk of concussion, Dr. Casey advises women to participate in exercises to enhance neck strength, stiffness and neuromuscular control, as females tend to have deficits in these areas relative to males. “Depending on the sport, exercises and training to optimize technique with high-risk movements, such as heading the ball in soccer, are also critical in reducing concussion risk."

Dr. Casey concluded, "If we truly want to reduce the impact of sports concussions, more research is needed on what causes concussions so that prevention measures can be put in place as well as better reporting of sex and gender differences across sports.”

Jennifer Cheng, PhD, Brittany Ammerman, BA, Kristen Santiago, BA, Bridget Jivanelli, MLIS, all from HSS, were co-authors for both manuscripts. Jo A. Hannafin, MD, PhD, and Emerald Lin, MD, from HSS were co-authors for the CORR and Sports Health publications, respectively.

References:

1) Daneshvar DH, Nowinski CJ, McKee AC, Cantu RC. The epidemiology of sport related concussion. Clin Sports Med. 2011;30:1-17.

2) Harmon KG, Drezner JA, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. 2013;47:15-26.

3) Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21:375-378.

4) Bryan MA, Rowhani-Rahbar A, Comstock RD, Rivara F; Seattle Sports Concussion Research Collaborative. Sports- and recreation-related concussions in US youth. Pediatrics. 2016;138:e20154635.

Reconstruction is the current standard of care surgical treatment for tears of the anterior cruciate ligament (ACL). This procedure typically uses a graft, or a piece of tissue, placed in the knee minimally invasively, using small incisions. About 300,000 ACL reconstructions are performed annually in the United States with well documented rates of success.

ACL repair is an older technique that involved suturing (sewing) torn ACL tissue, not rebuilding it with a graft. ACL repair was performed in the 1970s at select institutions, including Hospital for Special Surgery, but was abandoned due to unacceptably high failure rates of up to 50%.

Today, ACL repair has been modernized and can be performed through a minimally invasive approach. Proponents suggest that modern ACL repair techniques may be performed safely and may lead to a quicker recovery than ACL reconstruction. However, the limited studies to date raise questions that must be discussed in detail with your surgeon.

1. It is critically important to get ACL surgery right the first time.

When ACL surgery fails, surgeons must do a revision procedure to correct or revise the problems that were not fully addressed the first time. Revision requires reconstructive ACL surgery with a graft. (ACL repairs cannot be done as revisions.) Redoing ACL surgery may result in higher rates of failure, lower rates of return to sports, and increased risk of osteoarthritis.

The importance of successful initial ACL surgery holds true for people of all ages, but it is particularly critical for young athletes, for whom a failed surgery can have devastating consequences, including years lost from sport in the short term as well as chronic pain and loss of function in the long term.

2. Failure rates for ACL repair appear to be significantly higher than those for ACL reconstruction in people of all ages.

Current studies suggest that modern ACL repair techniques have a failure rate that may be five to ten times higher than that of ACL reconstruction^1,2,3. One major recent study in a prominent sports medicine journal found that arthroscopic ACL repair has unacceptable outcomes in young athletes, with short-term failure rates of close to 50%².

It has been suggested that ACL repair may be appropriate for older adults who have a type of ACL tear called a proximal avulsion and who do not participate in “cutting and pivoting” sports such as basketball, volleyball, and soccer. For these patients, failure rates in the short term appear to be much higher than ACL reconstruction in this age group^1,2,3.

3. There is still much we don’t know about ACL repair.

There has been no scientific evidence that shows a difference in postoperative pain between ACL repair and reconstruction. Rehabilitation and return-to-play protocols for ACL repair have not yet been established. Proper guidelines for rehabilitation and return to sports are essential to keep people safe from re-injury.
 

Andrew D. Pearle, MD

Chief, HSS Sports Medicine Institute

Bryan T. Kelly, MD

HSS Surgeon-in-Chief and Medical Director

Answorth A. Allen, MD

David W. Altchek, MD

Struan H. Coleman, MD, PhD

Frank A. Cordasco, MD, MS

David M. Dines, MD

Joshua S. Dines, MD

Stephen Fealy, MD

Andreas H. Gomoll, MD

Lawrence V. Gulotta, MD

Jo A. Hannafin, MD, PhD

Anne M. Kelly, MD

John D. MacGillivray, MD

Robert G. Marx, MD, MSc, FRCSC

Michael J. Maynard, MD

Moira M. McCarthy, MD

Danyal H. Nawabi, MD, FRCS

Stephen J. O’Brien, MD, MBA

Anil S. Ranawat, MD

Scott A. Rodeo, MD

Howard Anthony Rose, MD

Beth E. Shubin Stein, MD

Sabrina M. Strickland, MD

Karen M. Sutton, MD

Samuel A. Taylor, MD

Russell F. Warren, MD

Thomas L. Wickiewicz, MD

Riley J. Williams III, MD

References

1. Jonkergouw A, van der List J, DiFelice G. Arthroscopic primary repair of proximal ACL tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):21-28.

2. Gagliardi AG, Carry PM, Parikh HB, Traver JL, Howell DR, Albright JC. ACL repair with suture ligament augmentation is associated with a high failure rate among adolescent patients. Am J Sports Med. 2019 Mar;47(3):560-566.

3. Wright RW et al. Risk of tearing the intact ACL in the contralateral knee and rupturing the ACL graft during the first 2 years after ACLR: A prospective MOON cohort study. Am J Sports Med. 2007 Jul;35(7):1131-4.

For more information visit https://www.hss.edu/condition-list_torn-acl.asp.

Read the full article at beckersspine.com