Sports Medicine (2024) 54:779–780

https://doi.org/10.1007/s40279-023-01965-3

LETTER TO THE EDITOR

Response to Comment on: “Return to Sports: A Risky Business?

A Systematic Review with Meta‑analysis of Risk Factors for Graft
Rupture Following ACL Reconstruction”
Anna Cronström1,2 · Eva Tengman1 · Charlotte K. Häger1

Accepted: 30 October 2023 / Published online: 24 November 2023

© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2023

The authors thank Dr Duarte et al. [1] for their interest in
our recent paper “Return to sports: A risky business? A sys-
tematic review with meta-analysis of risk factors for graft
rupture following ACL reconstruction” [2] and just make
some brief comments in the context. Duarte et al. [1] are
bringing the radiologist’s perspective and reflecting on the
role of magnetic resonance imaging (MRI) in predicting a
safe return to sport, specifically in relation to graft charac-
teristics and surgery techniques, such as tunnel placement
and widening. We agree that this is certainly important
information that was not included in our paper since graft
types and factors related to surgery techniques as potential
risk factors for graft rupture were beyond the scope of our
review. The main reasons for our choice here were that there
are already recently published systematic reviews and meta-
analyses on the role of graft type in predicting graft failure
[3, 4], and that the importance of graft healing and surgery
techniques seems an entire field of its own that warrants
particular attention.
We nevertheless agree that MRI may be a useful tool in
the future for predicting the appropriate time of return to
sport. Standardized procedures for assessing, e.g. graft matu-
rity and healing are, however, needed [5], and as DeFroda
et al. [6] state in their review (referred to by Duarte et al.
[1]), ­T2 relaxation time may be a promising future measure
This comment is a reply to the letter by Duarte et al. available online
at https://​doi.​org/​10.​1007/​s40279-​023-​01964-4.
of graft healing that is not dependent on image acquisition
and machine manufacturer. We do welcome research on all
factors, including graft characteristics and different surgery
techniques, that may contribute to secure a safe return to
sport and minimize the risk of graft failure in patients with
anterior cruciate ligament reconstruction. In the meantime,
the application of MRI per se in the return to sport decision,
although potentially useful, would likely be highly depend-
ent on resources and interpretations at specific clinical and
sport settings.
Declarations
Funding No sources of funding were used to assist in the preparation
of this letter.
Conflicts of Interest Anna Cronström, Eva Tengman and Charlotte
Häger declare they have no conflicts of interest with the content of
this letter.
Availability of Data and Materials Not applicable.
Ethics Approval Not applicable.
Informed Consent Not applicable.
Author Contributions All authors contributed to this letter and read
and approved the final version.

This comment refers to the article available online at https://​doi.​org/​

References
10.​1007/​s40279-​022-​01747-3.
1. Duarte A, González-Gómez S, Rueda MA, Ortegon JDC. Com-
* Anna Cronström ment on: “Return to sports: A risky business? A systematic review
anna.cronstrom@umu.se with meta-analysis of risk factors for graft rupture following ACL
reconstruction.” Sports Med. 2023. https://​doi.​org/​10.​1007/​
1
Department of Community Medicine and Rehabilitation, s40279-​023-​01964-4.
Umeå University, Umeå, Sweden 2. Cronström A, Tengman E, Häger CK. Return to sports: a risky
business? A systematic review with meta-analysis of risk factors
2
Department of Health Sciences, Lund University, Lund,
Sweden

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