Long-term evaluation of pediatric ACL reconstruction: high risk of further surgery but a restrictive postoperative management was related to a lower revision rate

Abstract

Introduction The guidelines regarding rehabilitation after pediatric anterior cruciate ligament reconstruction (ACLR) are sparse. The aim of the study was to retrospectively describe the long-term outcome regarding further surgery and with special emphasis on the revision rate after two different postoperative rehabilitation programs following pediatric ACLR. Material and methods 193 consecutive patients < 15 years of age who had undergone ACLR at two centers, A (n = 116) and B (n = 77), in 2006–2010 were identified. Postoperative rehabilitation protocol at A: a brace locked in 30° of flexion with partial weight bearing for 3 weeks followed by another 3 weeks in the brace with limited range of motion 10°–90° and full weight bearing; return to sports after a minimum of 9 months. B: immediate free range of motion and weight bearing as tolerated; return to sports after a minimum of 6 months. The mean follow-up time was 6.9 (range 5–9) years. The mean age at ACLR was 13.2 years (range 7–14) years. The primary outcome measurement in the statistical analysis was the occurrence of revision. Multivariable logistic regression analysis was performed to investigate five potential risk factors: surgical center, sex, age at ACLR, time from injury to ACLR and graft diameter. Results Thirty-three percent had further surgery in the operated knee including a revision rate of 12%. Twelve percent underwent ACLR in the contralateral knee. The only significant variable in the statistical analysis according to the multivariable logistic regression analysis was surgical center (p = 0.019). Eight percent of the patients at center A and 19% of the patients at B underwent ACL revision. Conclusions Further surgery in the operated knee could be expected in one third of the cases including a revision rate of 12%. The study also disclosed a similar rate of contralateral ACLR at 12%. The revision rate following pediatric ACLR was lower in a center which applied a more restrictive rehabilitation protocol. Level of evidence Case-control study, Level III.

Combining Anterior Cruciate Ligament Reconstruction With Lateral Extra-Articular Procedures in Skeletally Immature Patients Is Safe and Associated With a Low Failure Rate

“…14 favored early surgical management in children. ACL reconstruction in young patients remains linked to a high rate of graft failure 15 , 16 , 17 and to potential growth disorders 18 , 19 : being a child has been described as a major risk factor for graft failure in comparison with an adult population in a large cohort of 5,479 patients (18.0% [pediatric <20 years old] vs 9.2% [adults 20-29 years old] and 7.1% [adults 30-39 years old]; P < .0001 at 5 years postoperatively). 20 …”

Return to Sport After Pediatric Anterior Cruciate Ligament Reconstruction: A Systematic Review of the Criteria

“…However, 2 independent variables were described as statistically significant predictive factors of graft rerupture. Three studies, Dekker et al, 10 Law et al, 28 and § § References 2,7,10,16,18,19,22,27,28,36,39,43,44. 1648 Lorange et al…”

“…Table 3 describes the only study that compared 2 groups with a combination of time and criteria in their RTS algorithm. Hansson et al 19 aimed to evaluate the long-term outcome of 2 different postoperative rehabilitation programs after pediatric ACLR. These 2 groups included patients >9 months after ACLR in addition to single-leg hop for distance, which should reach 90% LSI (group A; n = 116), and patients >6 months after surgery in addition to single-leg hop for distance, which should reach 90% LSI (group B; n = 77).…”

A systematic review of transphyseal ACL reconstruction in children and adolescents: comparing the transtibial and independent femoral tunnel drilling techniques

“…A total of 22 articles were identified that reported failure rates of transphyseal ACL reconstruction in children younger than 16 years [16–37]. In 16 studies (659 patients) a transtibial technique and in 6 studies (351 patients) an independent technique was used for drilling the femoral tunnel (Table 1).…”