Abstract
Background:
Return-to-sport assessments (RTSA) are widely used to evaluate functional readiness after anterior cruciate ligament reconstruction (ACLR), but current criteria are largely based on adult populations. Pediatric patients may differ in neuromuscular recovery and psychological readiness. Currently, limited data exist comparing RTSA outcomes between age groups. This study aimed to compare RTS performance metrics between pediatric patients undergoing physeal-sparing or physeal-respecting ACLR and adults undergoing conventional ACLR.
Hypothesis:
Adult patient will outperform pediatric patients on components of the RTSA that demand fully-developed neuromuscular control. The groups will be equivalent for psychological readiness.
Methods:
A retrospective cohort study was conducted on 152 patients (76 pediatric, 76 adult) who underwent standardized RTS testing between 2019 and 2024. Pediatric patients were identified based on radiographs demonstrating open physes and surgical technique. All participants completed a comprehensive, qualitatively- and quantitatively-scored, 18-component RTS test assessing strength, hop performance, balance, neuromuscular control, and psychological readiness. Comparative analyses were performed using independent t-tests and Mann-Whitney U tests to evaluate differences in test performance between groups.
Results:
The mean age was 23.3 ± 14.0 for the adult group and 14.4 ± 1.8 for the pediatric group. Mean time between surgery and RTSA was 9.5 ± 0.5 months for the adult group and 9.5 ± 2.0 months for the pediatric group (p = 0.69). Adults outperformed pediatric patients in the following tests: single-leg press strength (p = 0.033), hamstring strength (p = 0.003), hop symmetry for the 6-meter, lateral, and X-over hop tests (p = 0.003, 0.018, and 0.014, respectively), drop down jump (p < 0.001), vertical jump (p = 0.041), burpees (p = 0.013), and LEFT test speed (p = 0.002). Pediatric patients performed equally well as adults on the following tests: hip abduction strength, Y-balance tests, single-leg hop, triple hop, and medial hop (p > 0.05). The ACL-RSI score was higher for the pediatric group compared to the adult group but did not quite reach significance (82% vs 77%, p = 0.053).
Conclusion:
Pediatric patients demonstrate inferior RTS performance compared to adults on certain components of the RTSA at similar postoperative intervals following ACLR. Factors such as fatigue over the course of the test, flexibility, graft type, muscle strength, center of mass, and physiological maturity may contribute to the differences in test performance in adult versus pediatric patients. These findings highlight the need for age-specific RTS benchmarks and rehabilitation strategies that account for the unique physical and psychological needs of skeletally-immature athletes.