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

Abstract

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.

The Delaware‐Oslo ACL Cohort treatment algorithm yields superior outcomes to usual care 9–12 years after anterior cruciate ligament reconstruction

“…Noncompleters at follow-up were more often male and younger, which is consistent with previous reports [32,39]. Although the pattern of missingness may skew the results in both directions [40,41], the risk of selection bias can be estimated to be minor as differences in preoperative KOOS scores were trivial (mean differences <3 points).…”

Greater self‐efficacy, psychological readiness and return to sport amongst paediatric patients compared with adolescents and young adults, 8 and 12 months after ACL reconstruction

“…Similar to the results of the present study, previous studies have shown that younger patients report higher scores on the ACL-RSI compared with adults [ 32 ]. Younger patients have previously also been shown to be more content than adults with their knee function 1 year after ACL reconstruction [ 12 ], but the opposite findings have also been reported 2, 5 and 10 years after ACL reconstruction [ 26 ]. A recent study from the same patient registry showed that patients who had greater psychological readiness, i.e.…”

“…Young patients have been reported to have a high rate of return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction [ 3 , 16 , 19 ]; however, early RTS has also been associated with a high rate of graft rupture and contralateral ACL injury [ 16 ]. Adolescents have reported a lower rate of acceptable knee function after ACL reconstruction and run an increased risk of sustaining a second ACL injury compared with their older counterparts [ 26 , 27 ]. In addition, adolescents have previously been reported to return to knee-strenuous sports earlier than young adults, without having recovered acceptable knee function after ACL reconstruction [ 3 ].…”

What’s New in Pediatric Orthopaedics

“…Results from the Swedish National Knee Ligament Register demonstrated that adolescents reported a lower score than young adults on the Knee injury and Osteoarthritis Outcome Score (KOOS) at the 2, 5, and 10-year follow-ups after an anterior cruciate ligament (ACL) reconstruction 74 . The reason for this is unclear, but the authors postulated that it might be due to adolescents returning to activities faster than young adults.…”