Summary

Cartilage injury at the time of pediatric and adolescent ACL reconstruction is a negative predictor of return to sport.

Abstract

Purpose

Anterior cruciate ligament (ACL) injury in young athletes is often considered to be a career-threatening condition. In spite of much research, there is a lack of evidence on this topic, especially when it comes to children and adolescents. The purpose of this study was to evaluate clinical outcomes, the level and rate of return to sport (RTS), and predictive factors for RTS after pediatric and adolescent ACL reconstruction.

Methods

Patients aged between 10 and 18 years at the time of primary ACL reconstruction that were registered in the Swedish National Knee Ligament Registry (SNKLR) were screened for eligibility. Based on the age at time of ACL reconstruction, patients were divided into pediatric (females: 11-13 years; males: 11-15 years) and adolescent (females: 14-18 years; males: 16-18 years) patients. Demographic, injury-related, and treatment-specific data, and subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline and the one-, two-, five- and 10-year follow-ups were obtained from the SNKLR. A survey developed by experts in the management of ACL injuries was sent to all patients to determine sport specific variables and RTS rates.

Results

Overall, 1,392 patients were included in this study. There were 81 pediatric patients (mean age at ACL reconstruction, 13.7 ± 1.4 years) and 1,311 adolescent patients (mean age at ACL reconstruction, 16.5 ± 1.2 years). There were significantly more female patients in the adolescent group than in the pediatric group (76% vs. 24%, p<0.0001). Significant improvements in KOOS subscales ADL, Sport/Rec, and QOL from preoperative to the 1-, 2-, 5-, and 10-year follow-ups were observed after pediatric ACLR (p < 0.05). Significant improvements in all KOOS subscales from preoperative to the 1-, 2-, 5-, and 10-year follow-ups were observed after adolescent ACLR (p < 0.0001). After ACL reconstruction, 74% of pediatric patients and 68% of adolescent patients returned to their previous type of sport. Moreover, 31% of pediatric patients and 23% of adolescent patients became elite athletes after ACL reconstruction. Cartilage injury at the time of ACL reconstruction was found to lower the odds of pediatric and adolescent patients returning to their previous type of sport (odds ratio, 0.60; p=0.001).

Conclusion

Long-lasting clinical improvements and high RTS rates can be expected after pediatric and adolescent ACL reconstruction. Moreover, young athletes still have the chance to compete in elite-level sports after ACL reconstruction.