Outcomes and Return to Sport After Revision Anterior Cruciate Ligament Reconstruction in Adolescent Athletes

Abstract

Background:The number of adolescent anterior cruciate ligament (ACL) injuries is rising with increased participation in higher level athletics at earlier ages. With an increasing number of primary ACL reconstructions (ACLRs) comes a rise in the incidence of revision ACLRs.Purpose:To evaluate the clinical results of revision ACLR across a group of high-level adolescent athletes with at least 2-year follow-up.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review of 21 adolescent athletes (age range, 10-19 years) who underwent revision ACLR with at least 2-year follow-up was conducted. Patient-reported outcome measures (PROMs) included the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Lysholm knee scoring scale, Tegner activity level scale, and modified Cincinnati Knee Rating System. Return to sport (RTS) and overall patient satisfaction were also assessed.Results:The mean age at the time of surgery was 16.5 years (range, 14-19 years), and the mean follow-up was 46.4 months (range, 24-97 months); 42.9% of patients were female, and 52.4% of patients participated in collision sports. The mean time to failure after primary ACLR was 13.1 ± 8.0 months, and the most common mechanism of failure was noncontact in at least 66.7% of cases. The revision graft type included bone–patellar tendon–bone (BPTB) in 71.4% of cases; 26.7% of BPTB grafts were from the contralateral extremity. Concomitant procedures were performed for intra-articular lesions in 71.4% of patients. The mean patient satisfaction rate was 95.3%. There were 3 cases of a graft reinjury at a mean of 25 months postoperatively. The mean PROM scores were as follows: IKDC, 87.5 ± 12.7; Tegner, 7.2 ± 2.0; Lysholm, 93.7 ± 9.8; and Cincinnati, 93.4 ± 10.0. Of those attempting to RTS, 68.4% of patients successfully returned at the same level of competition. Patients with a lateral compartment chondral injury were less likely to RTS (P < .05). Independent variables shown to have no significant relationship to PROMs or RTS included age, follow-up, sport classification, associated meniscal tears, revision graft size/type, and concomitant procedures.Conclusion:Revision ACLR can be an effective surgical option in adolescents participating in collision and contact sports, with good to excellent subjective outcome scores. At a minimum 2-year follow-up, a graft rupture after revision ACLR occurred in 14% of cases. Of the athletes attempting to RTS, 68.4% returned to their preinjury level of competition.

Clinical Outcomes of Arthroscopic Primary Anterior Cruciate Ligament Repair: A Systematic Review from the Scientific Anterior Cruciate Ligament Network International Study Group

“…This range of variability is consistent with data published for ACL reconstruction and not as high as in some series reporting outcomes of ACLR in young athletes participating in pivoting sports. [58][59][60] Comparative studies only reported graft rupture rates at shorter durations of follow-up. Although it is promising to note a lack of significant difference in graft rupture rates in the comparative studies, they were associated with a high risk of bias with respect to MINORS criteria and specific limitations included a lack of randomization, a small study population, and an absence of a sample size 50 and Henle et al, 36 do not report the rehabilitation protocol followed.…”

A research update on the state of play for return to sport after anterior cruciate ligament reconstruction

“…The review is however limited by the availability of only 4 studies in competitive athletes and only two studies with larger (> 100) patient numbers. A more recent study has also shown higher return to competitive sport rates (68%) after revision reconstruction in adolescent athletes [9].…”

Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-Articular Tenodesis in Skeletally Immature Patients: Surgical Technique

“…Recent studies have reported that isolated ACL reconstructions in pediatric athletes have a 10% to 25% graft re-rupture rate, with less than 70% of patients reported to return to sport. 12,[17][18][19][20] In addition, patients with generalized hypermobility and increased heel height/knee hyperextension have reported high ACL reinjury rates. [21][22][23] Recent systematic reviews have reported that extra-articular procedures reduce knee instability observed on the pivot shift maneuver and subsequently decrease the forces on the ACL graft.…”