Return to Sport After Bone–Patellar Tendon–Bone Autograft ACL Reconstruction in High School–Aged Athletes

Abstract

Background: Anterior cruciate ligament (ACL) injuries are occurring with increasing frequency in the adolescent population. Outcomes after ACL reconstruction (ACLR) are inconsistently reported in homogeneous patient populations. Purpose/Hypothesis: To evaluate outcomes after bone–patellar tendon–bone (BTB) autograft ACLR in competitive high school–aged athletes by examining return to sport (RTS), patient satisfaction, and reinjury rates. Our hypothesis was that RTS rates and satisfaction will be high and reinjury rates will be low. Study Design: Case series; Level of evidence, 4. Methods: An institutional ACL registry was utilized to identify competitive high school–aged athletes (14-18 years old) who underwent primary ACLR using BTB autograft with a minimum 2-year follow-up. A postoperative questionnaire was administered to determine rates and types of RTS, quality of sports performance, reinjury, and satisfaction. Uni- and multivariable analyses were used to identify demographic, sport-specific, and clinical factors related to RTS. Results: A total of 53 patients were included (mean ± SD age at the time of surgery, 16.6 ± 1.34 years). Mean follow-up was 3.78 ± 0.70 years (range, 2.60-4.94 years). The overall ipsilateral ACL retear rate was 7.5% (n = 4). There were 10 subsequent ACL tears to the contralateral knee (19%). Forty-four (83%) patients successfully returned to at least their prior level of sport at a mean 10.5 ± 8.7 months (range, 3-48 months). Overall satisfaction was high, with 91% of patients very satisfied with the outcome. Higher confidence levels regarding performance of the reconstructed knee were associated with increased probability of RTS on multivariate analysis. Conclusion: BTB autograft ACLR results in high rates of RTS and satisfaction and low rates of subsequent ipsilateral ACL injuries in competitive high school–aged athletes. Patients with higher confidence in performance of the reconstructed knee are more likely to return to at least their prior level of sport.

Bone‐patellar tendon‐bone autograft is associated with a higher rate of return to preinjury levels of performance in high‐level athletes than anterior cruciate ligament reconstruction using hamstring autograft

“…The timing of RTP after ACL‐R using BPTB autograft (9.7 months) was significantly earlier than that using HT autograft (10.5 months). These results were similar when compared with previous studies evaluating RTP among athletes [17, 25, 34]. Irvine et al [18] indicated that the timeline for graft healing has implications for RTS.…”

Is There an Association in Young Patients Between Quadriceps or Hamstring Strength After ACL Reconstruction and Graft Rupture?

“…2,24,32,38,41 A further difference between the current study and others is that all patients in the current study received a hamstring tendon graft, whereas the populations in other studies received a mix of both hamstring tendon and patellar tendon grafts. 4,12,17,22 When studying a cohort of 53 similarly young patients who had undergone ACL reconstruction with a patellar tendon graft, Rauck et al 31 reported a graft rupture rate of 7.4%, which is not dissimilar to the finding of the current study. It is not clear whether their patients underwent strength testing.…”

Return to Play and Performance After Anterior Cruciate Ligament Reconstruction in Soccer Players: A Systematic Review of Recent Evidence

“…The authors reported that the soccer players were able to RTP following a period of between 6.1 and 11.1 months. However, even though 8.7 months represents a significant period of absence from soccer matches, the recovery time highlighted in this research is considerably shorter compared with studies performed on samples of NFL [51,52], NBA [24], schoolaged [53], amateur [54], and recreational athletes [55]. For instance, RTP times of 9.8 [24] and 12.6 [52] months were recorded for NBA and NFL players, respectively.…”