Adolescents Have Twice the Revision Rate of Young Adults After ACL Reconstruction With Hamstring Tendon Autograft: A Study From the Swedish National Knee Ligament Registry

Thorolfsson, Baldur; Svantesson, Eleonor; Snaebjörnsson, Thorkell; Sansone, Mikael; Karlsson, Jón; Samuelsson, Kristian; Senorski, Eric Hamrin

doi:10.1177/23259671211038893

Cited by 16 publications

(17 citation statements)

References 40 publications

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“…Current literature reports better results, in terms of patient-reported outcomes and risk of ACL revision, after anterior cruciate ligament (ACL) reconstruction in adults [1][2][3][4] compared with ACL reconstruction in children and adolescents [5][6][7][8][9]. Outcomes in youth ACL literature vary widely [10] and there are very few, if any, studies published with a large cohort of patients that primarily focus on patient-reported outcomes after ACL reconstruction in children and adolescents.…”

Section: Introductionmentioning

confidence: 99%

Lower rate of acceptable knee function in adolescents compared with young adults five years after acl reconstruction: results from the swedish national knee ligament register

Thorolfsson

Lundgren

Snaebjörnsson

et al. 2022

BMC Musculoskelet Disord

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Background The number of studies with a large cohort of patients that primarily focus on patient-reported outcomes after ACL reconstruction in children and adolescents is limited. The purpose of the present study was to determine whether patient age affects the proportion of patients that achieve a patient-acceptable symptom state (PASS) on the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales one, two, five and 10 years after an ACL reconstruction. Methods The patient data in the present study were extracted from the Swedish National Knee Ligament Register (SNKLR). Patients aged between five and 35 years that underwent a primary ACL reconstruction between 1 January 2005 and 31 December 2017 and had completed the KOOS questionnaire at the one-, two-, five- or 10-year follow-up were included. A total of 2,848 patients met the inclusion criteria and were included in the study; 47 paediatric patients (females 5–13, males 5–15 years), 522 adolescents (females 14–19, males 16–19 years) and 2,279 young adults (females 20–35, males 20–35 years). The results from the KOOS were presented as the mean and 95% confidence interval (CI) for the mean. For comparisons between groups, the chi-square test was used for non-ordered categorical variables. For pairwise comparisons between groups, Fisher’s exact test (2-sided) was used for dichotomous variables. All the statistical analyses was set at 5%. Results Adolescents reported a significantly lower score than young adults on the KOOS4 at the two- (68.4 vs. 72.1; P < 0.05), five- (69.8 vs. 76.0; P < 0.05) and 10-year follow-ups (69.8 vs. 78.2; P < 0.05). Moreover, a significantly smaller proportion of adolescents achieved a PASS on each of the KOOS subscales when compared with young adults at the five-year follow-up (Symptoms: 83.3% vs. 91.6%; Pain: 42.9% vs. 55.3%; Function in daily living: 31.4% vs. 41.1%; Function in sports and recreational activities: 42.3% vs. 55.7%; Knee-related quality of life: 50.0% vs. 65.0%; P < 0.05). Conclusions A significantly smaller proportion of adolescents achieved a PASS on each of the KOOS subscales when compared with young adults five years after ACL reconstruction. The results of the present study provide important information for physicians and physiotherapists treating young patients after an ACL injury and they can aid in providing realistic expectations in terms of the mid- and long-term outcomes. Level of evidence Prospective Observational Register/Cohort Study, Level II.

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Section: Introductionmentioning

confidence: 99%

Lower rate of acceptable knee function in adolescents compared with young adults five years after acl reconstruction: results from the swedish national knee ligament register

Thorolfsson

Lundgren

Snaebjörnsson

et al. 2022

BMC Musculoskelet Disord

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“…25 This stands in contrast to a study done using the Swedish registry data which found an overall revision rate after ACLR of 1.1% and 2.6% at 2 years and 5 years respectively. 26 The authors note that patients may have been exposed to less sporting activity which may help explain their low revision rate compared to others noted in the pediatric and adolescent literature. The median age of our patients in this study was 16 years with an average time to reoperation for revision ACLR of 16.6 months and contralateral ACLR of 22.1 months.…”

Section: Discussionmentioning

confidence: 85%

Risk of reoperation after primary anterior cruciate ligament reconstruction in children and adolescents

Nester

Torino

Sylvestre

et al. 2022

J Orthop Surg (Hong Kong)

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Objective To examine the incidence and risk factors of any-cause reoperation after primary ACLR in children and adolescents. Design Retrospective Cohort Setting Electronic medical records from a large tertiary care, single institution integrated healthcare delivery system. Patients Patients were under the age of 18 years and had anterior cruciate ligament reconstruction. They were excluded if they had a multi-ligamentous knee injury or <1 year follow-up. Interventions Patients were further identified to have undergone a subsequent knee operation ipsilaterally or contralateral ACLR. Main outcome measures The rate of any-cause reoperation was our primary outcome measure. Results The median age was 16. There were 208 females (53.9%) and 178 males (46.1%) included. The median follow-up was 25 months with a minimum of 12 months (interquartile range: 16.0, 46.0). The rate of any-cause reoperation was 34.7%. There was no statistically significant difference between those who underwent reoperation versus those who did not undergo reoperation relative to age, sex, BMI, graft type, or the presence of concomitant meniscal injury. The rates of ipsilateral ACLR and contralateral ACLR at any time during the study period was 8.0% and 10.9% respectively. There was no statistically significant difference for rate of reoperation between graft types, between various concomitant injuries, between those who underwent meniscus repair or no repair. Conclusions This study reflects a 34.7% rate of a subsequent knee operation after ACLR in patients younger than 18 years. These findings can be used to inform pediatric patients undergoing primary ACLR on their risk of returning to the operating room.

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“…In young active patients, the risk of reconstruction failure increases with higher activity levels. 1 A variety of different methods are used to define return to activity. Return to activity may involve a patient returning to casual, amateur, or competitive level of sport, or analyzing scores calculated from an activity questionnaire such as the Marx Activity Questionnaire or the Tegner Activity Scale.…”

Section: Discussionmentioning

confidence: 99%

“…Reconstructing the ACL-deficient knee may also reduce the risk of long-term complications due to instability, such as injury to the menisci and cartilage. 1 , 2 Additionally, reconstruction has been shown to be economically advantageous with an increase in quality-of-life compared to rehabilitation and non-operative management. 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

Optimal Graft Choice in Athletic Patients with Anterior Cruciate Ligament Injuries: Review and Clinical Insights

Sim¹,

Rahardja²,

Zhu³

et al. 2022

OAJSM

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Anterior cruciate ligament (ACL) rupture is a common sporting-related knee injury with a potentially detrimental impact on the athlete’s career, yet there is no formal consensus on the optimal graft choice for reconstructing the ruptured ACL in this specific population. Options for reconstruction include autograft, allograft, and artificial grafts. However, each has associated failure risk and donor site morbidity. Our operational definition of the athlete is a skeletally mature individual participating in high level activity with the expectation to return to pre-injury level of activity. The athlete has unique injury characteristics, post-operative expectations, and graft demands that differ to the general population. Long-term outcomes are of particular importance given on-going mechanical demands on the reconstructed knee. Therefore, the purpose of this review is to consolidate current literature on the various ACL reconstruction graft options, with a focus on the optimal graft for returning the athlete to activity with the lowest rate of re-injury.

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Adolescents Have Twice the Revision Rate of Young Adults After ACL Reconstruction With Hamstring Tendon Autograft: A Study From the Swedish National Knee Ligament Registry

Cited by 16 publications

References 40 publications

Lower rate of acceptable knee function in adolescents compared with young adults five years after acl reconstruction: results from the swedish national knee ligament register

Lower rate of acceptable knee function in adolescents compared with young adults five years after acl reconstruction: results from the swedish national knee ligament register

Risk of reoperation after primary anterior cruciate ligament reconstruction in children and adolescents

Optimal Graft Choice in Athletic Patients with Anterior Cruciate Ligament Injuries: Review and Clinical Insights

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