Abstract
BACKGROUND
Anterior cruciate ligament (ACL) injuries have become increasingly common in pediatric and adolescent patients over the last several decades, as this population has become more involved in athletic competition. ACL injuries in skeletally immature patients had historically been treated conservatively with bracing and activity modification; however, poor outcomes including extensive chondral and meniscal damage, increased recurrent instability, and increased sports drop out rates have been observed. Recognition of these poor outcomes has led to a shift towards early operative treatment, resulting in a significant rise in the number of pediatric ACL reconstructions being performed. Yet, a higher failure rate has been noted in this younger population within larger adult cohort studies. The purpose of this study was to evaluate the re-tear and re-operation rates in pediatric and adolescent ACL reconstruction.
METHODS
The was a retrospective review of pediatric and adolescent patients treated at a single tertiary children’s hospital for ACL reconstruction from 2011 to 2017 by the same pediatric orthopedic surgeon. Review of the electronic medical record was performed to obtain patient demographics, preoperative clinical and radiographic findings, operative notes, and postoperative outcomes. Re-tear and re-operation rates were calculated.
RESULTS
A total of 308 patients were identified during the study period of which sixty-six percent were female. The mean age of patients was 15.8 years with a mean follow-up of 1.8 +/- 0.8 years. Two-hundred fifty-three hamstring autografts (mean age 15.7+/- 4.1 years) and 55 bone tendon bone autograft (mean age 16.9 +/- 1.45 years) were performed. Two hundred forty-three patents had adult-style reconstructions performed, 40 had transphyseal reconstructions, 24 had partial transphyseal reconstruction, and 1 patient had an all-epiphyseal reconstruction. Average hamstring graft size was 8.3 mm +/- 0.5 mm and all BTB graft were 9 mm.
The overall graft re-tear rate was 8.2%. The overall re-operation rate was 13.2% (17 revisions, 5 medial meniscus repairs, 3 I+D’s, 2 cyclops debridements, 1 removal of hardware, and 1 manipulation under anesthesia). The highest re-tear (12.5%) and re-operation (22.5%) rates were found in patients who underwent a transphyseal reconstruction. No growth disturbances which required surgical intervention were noted.
CONCLUSIONS / SIGNIFICANCE
Pediatric and adolescent ACL reconstruction can be performed safely without a risk of growth disturbance. Patients had a high re-tear and re-operation rate; particularly in patients who underwent transphyseal reconstruction. Strategies must be developed to decrease the re-tear and re-operation rate in this population.