Abstract
Background
There is an increased risk of anterior cruciate ligament (ACL) rupture and subsequent
ACL reconstruction in patients <18 years old due to their high levels of sporting
participation.
Purpose
The purpose of this study was to assess the rate and timing of return to play (RTP)
in paediatric and adolescent patients following ACL reconstruction, and to compare
the outcomes between those undergoing ACL reconstruction with bone patella tendon
bone autograft (BTB) and hamstring tendon (HT) autograft.
Study Design
Level of Evidence: Level III; Retrospective Comparative Cohort Study.
Methods
The institutional ACL registry was screened for patients <18 that had undergone a
primary ACL reconstruction. Outcomes were analysed for patients undergoing either
a BTB or HT autograft for rate and timing of return to play, functional outcomes and
subsequent knee injuries. Statistical analysis was performed using SPSS.
Results
358 (BTB; 253, HT; 105) patients were followed up for 24-months (95% follow up). 86
athletes (27 BTB; 59 HT) were aged 13–15 years old with no significant difference
in RTP rate or timing between graft types, however, there was a difference in ipsilateral
re-ruptures (10.2% HT vs 0% BTB p = 0.03). 272 athletes (226 BTB; 46 HT) were aged
16–18 years old with no significant difference in RTP rate or timing between graft
types, or ipsilateral re-ruptures (8.7% HT vs 2.7% BTB p = 0.07). Concurrent ligament,
meniscal or chondral injuries found at the time was treated as necessary.
Conclusion
Paediatric and adolescent patients undergoing ACL reconstruction with either BTB or
HT had high rates of return to play. This was seen in both subgroups with 13–15-year-olds
mostly receiving a HT graft repair and 16–18-year-olds mainly receiving a BTB repair.
A moderate re-rupture rate was seen at 24-months. However longer follow up is needed
to truly see the long-term impact of such an injury at such a young age.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The KneeAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Incidence of Anterior Cruciate Ligament Tears and Reconstruction A 21-Year Population-Based Study.Am J Sports Med. 2016; 44: 1502-1507
- Hewett TE (2014) Anterior Cruciate Ligament Injuries: Diagnosis, Treatment, and Prevention abstract.Am Acad Pediatr. 2014; 133: e1437-e1450
- Return to sport and re-tears after anterior cruciate ligament reconstruction in children and adolescents.Orthop Traumatol Surg Res. 2018; 104: S183-S188
- Treating anterior cruciate ligament tears in skeletally immature patients. Arthroscopy - Journal of Arthroscopic and Related Surgery W.B. Saunders.Arthroscopy. 2011; 27: 704-716
- Return to Sport after Anterior Cruciate Ligament Reconstruction in the Skeletally Immature Athlete.Clin J Sport Med. 2016; 4: 266-271
- Return to sport after pediatric anterior cruciate ligament reconstruction and its effect on subsequent anterior cruciate ligament injury.J Bone Joint Surg Am. 2017; 99: 897-904
- Anterior Cruciate Ligament Tears in Children and Adolescents A Meta-analysis of Nonoperative Versus Operative Treatment.Am J Sports Med. 2014; 42: 2769-2776
Webster KE, Feller JA, Whitehead TS, Myer GD, Merory PB (2017) Return to Sport in the Younger Patient With Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 5(4):2325967117703399.
- The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction.Br J Sports Med. 2014; 48: 1613-1619
- Return to Level I Sports After Anterior Cruciate Ligament Reconstruction: Evaluation of Age, Sex, and Readiness to Return Criteria. Orthop.J Sports Med. 2018; (2;6(8):2325967118788045)
- How Is Psychological Outcome Related to Knee Function and Return to Sport Among Adolescent Athletes After Anterior Cruciate Ligament Reconstruction?.Am J Sports Med. 2019; 47: 1567-1575
- Fifteen-Year Survival of Endoscopic Anterior Cruciate Ligament Reconstruction in Patients Aged 18 Years and Younger.Am J Sports Med. 2016; 44: 384-392
- Young athletes return too early to knee-strenuous sport, without acceptable knee function after anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 1966-1974
- Increased incidence of anterior cruciate ligament revision surgery in paediatric verses adult population.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 1362-1366
- Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction A Systematic Review and Meta-analysis.Am J Sports Med. 2016; 44: 1861-1876
- International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 989-1010
- Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 1019-1036
- Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis.BMJ. 2006; 332: 995-1001https://doi.org/10.1136/bmj.38784.384109.2F
- Graft failure is more frequent after hamstring than patellar tendon autograft.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 3537-3546
- Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes.Br J Sports Med. 2018; 52: 128-138
- Increased Risk of Revision With Hamstring Tendon Grafts Compared With Patellar Tendon Grafts After Anterior Cruciate Ligament Reconstruction A Study of 12,643 Patients From the Norwegian Cruciate Ligament Registry, 2004–2012.Am J Sports Med. 2014; 42: 285-291
Prentice HA, Lind M, Mouton C, Persson A, Magnusson H, Gabr A, Seil R, et al. Patient; 2018.
- A Qualitative Investigation of the Decision to Return to Sport After Anterior Cruciate Ligament Reconstruction To Play or Not to Play.Am J Sports Med. 2014; 42: 336-342
Article info
Publication history
Published online: June 18, 2022
Accepted:
May 31,
2022
Received in revised form:
April 18,
2022
Received:
January 24,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
