Background

The prevalence of anterior cruciate ligament (ACL) injury and reconstruction surgery continues to increase in adolescent athletes. Younger age at surgery is also a significant risk factor for multiple ACL injuries. Despite this growing concern, the long-term impact of having multiple ACL injuries at a young age has not been fully determined. Therefore, the purpose of this study was to follow a cohort of adolescent patients and compare long-term data on a several important outcomes including sport participation, surgical satisfaction and quality of life, between those who had one compared to two ACL reconstruction surgeries at a young age.

Methods

Patients who had undergone primary ACL reconstruction surgery prior to the age of 18 years, and were a minimum of 10 years post-surgery were eligible to participate. Patients who sustained a second ACL injury were included if the subsequent injury occurred within 5 years of the initial surgery. Patients with a greater than 5-year interval between ACL surgeries were excluded as were patients who had a third ACL injury over the follow-up period. Patients were sent a bespoke survey which contained return to sport questions, questions related to overall satisfaction, the patient acceptable symptom state (PASS), IKDC subjective knee form, and quality of life measures (knee specific: KOOS-QoL; general: SF-12). Comparisons were made between patients who had one compared to two ACL reconstruction surgeries.

Results

The study cohort consisted of 71 patients (39 female, 32 male; mean operative age 16 years) who participated in the study at an average of 13 years (range 10-17 years) post primary ACL reconstruction surgery (single surgery group mean age 29 years; two surgery group mean age 30 years). All patients competed in competition sports prior to injury and all but 8 (63/71 =89%) returned to competition sport following surgery, with similar return rates between patients with one (45/50, 90%) versus two (18/21, 86%) ACL reconstructions. However, patients who had only one ACL reconstruction, were almost twice as likely to still be participating in competition sport at follow-up than those with two ACL surgeries (46% vs 24% still playing). All but 2 patients (both had one ACL surgery) considered the current state of their knee satisfactory (PASS rated yes) and there were no significant differences in overall function (90 vs. 85 out of 100) satisfaction with surgery (93 vs 90 out of 100) or IKDC subjective knee scores (91 vs 86 out of 100) between the group with one compared to two ACL reconstruction surgeries, respectively. Knee related quality of life (QoL) was significantly lower in those with two ACL surgeries (89 vs. 76, p<0.01) but general QoL was not significantly different between the groups for either physical or mental component summary scores.

Conclusion

Adolescent athletes who have two ACL reconstruction surgeries at a young age can have excellent outcomes with high levels of satisfaction at long term follow-up. However, they are less likely to be still participating in competition sport in the longer term and have poorer knee related quality of life compared to their single surgery counterparts.