Patient-Reported Outcomes, Return-to-Sport Status, and Reinjury Rates After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes: Minimum 2-Year Follow-up

Abstract

Background: Significant variation exists in the published rates of return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR). Functional outcomes and psychological response to injury have been implicated as factors that influence return to sport. Most studies focus on patients aged in the mid-20s, and less is known about this topic in adolescents. Purpose: To report midterm ACLR results for adolescent patients with regard to return to primary sport, patient-reported outcomes, and reinjury rate. Study Design: Case-control study; Level of evidence, 3. Methods: Adolescent athletes were contacted at a minimum of 2 years after ACLR. Patients completed 2 patient-reported outcome measures, the ACL--Return to Sport After Injury (ACL-RSI) and the International Knee Documentation Committee (IKDC) subjective form, and responded to questions regarding preinjury primary sport and level of competition, post-ACLR return to primary sport status, and reinjury. Results: A total of 74 patients (mean ± SD surgical age, 15.9 ± 1.5 years; follow-up age, 19.9 ± 2.0 years; response rate, 24.5%) completed the surveys at a mean of 4.0 ± 2.0 years after primary ACLR. Outcome scores averaged 90.3 ± 12.3 for IKDC and 81.6 ± 20.4 for ACL-RSI. Questionnaire responses indicated that 27.0% of patients did not return to or sustain primary sport participation after ACLR; the principal reasons were poor knee function, team/training change, and fear of another injury. Both IKDC and ACL-RSI scores were statistically lower in patients who did not successfully return to their primary sport in contrast to patients who successfully resumed their primary sport (IKDC, P = .026; ACL-RSI, P < .001). IKDC and ACL-RSI scores were moderately positively correlated with one another ( r Spearman = 0.60). There were 18 patients (reinjury rate, 24.3%) who suffered another ACL injury; 8 of these injuries included ipsilateral ACL graft tear (retear rate, 10.8%). Conclusion: In our cohort, 73% of adolescent patients successfully returned to their primary preinjury sport at a minimum of 2 years after ACLR. Both knee function and psychological responses to injury were important in determining an adolescent athlete’s return to sport. The findings support the use of the IKDC and ACL-RSI at midterm follow-up, with higher scores associated with a greater likelihood of adolescent patients returning to sport after ACLR.

Perception of stability correlates with objective performance of dynamic stability for people with chronic ankle instability

“…There was, however, a difference in the patient-reported outcome (International Knee Documentation Committee Subjective Knee Evaluation Form score: 95.52 vs 82.76, p = 0.03) [34]. Fones et al [33] also found that patient-reported outcomes were significantly lower in the people who did not return to sport in adolescents after 2 years post-surgery. The results suggest that PROs may be able to detect ongoing symptoms affecting patients' wellbeing that cannot be fully detected using traditional functional test batteries [34].…”

“…The relationship between stability and the perception of stability becomes more prominent when preparing for return to play following an injury. Psychological readiness and physical performance have not been researched in people with CAI previously, however, it has been reported following ACL reconstruction (ACLR) surgery [33,34]. Following ACLR, it has been reported that there were no functional differences for any of the tests conducted between the participants who did and did not return to sport.…”

Comparison of Knee Function and Activity Level Between Bilateral and Unilateral ACL Reconstruction: A Matched-Group Analysis With Minimum 5-Year Follow-up

“…For the question "How would you rate your knee function on a 10-point scale?" the patients who underwent bilateral ACLR scored significantly lower compared with the unilateral ACLR group (median [IQR], 7 [5][6][7][8] vs 8 [7][8][9], respectively; P < .001). Within the bilateral ACLR group, there were no significant differences regarding knee satisfaction between the first and contralateral ACL-reconstructed knee (Table 3).…”

“…After the first ACLR, the bilateral ACLR group reported a higher return to the same sport (88% vs 54%; P < .001) and preinjury activity level (66% vs 45%; P ¼ .003) compared with the unilateral ACLR group. Patients in the bilateral ACLR group had a significantly higher Tegner score after the first ACLR (median [IQR], 8 [7][8][9] vs 6 [6][7][8] for the unilateral group; P < .001). After the second ACLR (in the bilateral ACLR group), 61% of the patients returned to the same sport and 41% returned to their preinjury activity level.…”

“…At follow-up, both groups had a reduced activity level, but there were no significant differences between the groups. However, patients in the bilateral ACLR group were significantly less satisfied (median [IQR], 7 [4][5][6][7][8][9] vs 8 [6][7][8][9][10] for the unilateral group; P ¼ .047) with their activity level (Table 3). Fear of suffering another injury was the most common reason in both groups for not returning to their preinjury activity level (Table 4).…”