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Return to play in paediatric & adolescent patients following anterior cruciate ligament reconstruction

      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

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      References

        • Sanders T.L.
        • Maradit Kremers H.
        • Bryan A.J.
        • Larson D.R.
        • Dahm D.L.
        • Levy B.A.
        • et al.
        Incidence of Anterior Cruciate Ligament Tears and Reconstruction A 21-Year Population-Based Study.
        Am J Sports Med. 2016; 44: 1502-1507
        • LaBella C.R.
        • Hennrikus W.
        • Hewett T.E.
        • Brenner J.S.
        • Brookes M.A.
        • Demorest R.A.
        • et al.
        Hewett TE (2014) Anterior Cruciate Ligament Injuries: Diagnosis, Treatment, and Prevention abstract.
        Am Acad Pediatr. 2014; 133: e1437-e1450
        • Geffroy L.
        • Lefevre N.
        • Thevenin-Lemoine C.
        • Peyronnet A.
        • Lakhal W.
        • Fayard J.M.
        • et al.
        Return to sport and re-tears after anterior cruciate ligament reconstruction in children and adolescents.
        Orthop Traumatol Surg Res. 2018; 104: S183-S188
        • Vavken P.
        • Murray M.M.
        Treating anterior cruciate ligament tears in skeletally immature patients. Arthroscopy - Journal of Arthroscopic and Related Surgery W.B. Saunders.
        Arthroscopy. 2011; 27: 704-716
        • Chicorelli A.M.
        • Micheli L.J.
        • Kelly M.
        • Zurakowski D.
        • MacDougall R.
        Return to Sport after Anterior Cruciate Ligament Reconstruction in the Skeletally Immature Athlete.
        Clin J Sport Med. 2016; 4: 266-271
        • Dekker T.J.
        • Godin J.A.
        • Dale K.M.
        • Garrett W.E.
        • Taylor D.C.
        • Riboh J.C.
        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
        • Ramski D.E.
        • Kanj W.W.
        • Franklin C.C.
        • Baldwin K.D.
        • Ganley T.J.
        Anterior Cruciate Ligament Tears in Children and Adolescents A Meta-analysis of Nonoperative Versus Operative Treatment.
        Am J Sports Med. 2014; 42: 2769-2776
      1. 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.

        • Ardern C.L.
        • Österberg A.
        • Tagesson S.
        • Gauffin H.
        • Webster K.E.
        • Kvist J.
        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
        • Webster K.E.
        • Feller J.A.
        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)
        • Beischer S.
        • Hamrin Senorski E.
        • Thomeé C.
        • Samuelsson K.
        • Thomeé R.
        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
        • Morgan M.D.
        • Salmon L.J.
        • Waller A.
        • Roe J.P.
        • Pinczewski L.A.
        Fifteen-Year Survival of Endoscopic Anterior Cruciate Ligament Reconstruction in Patients Aged 18 Years and Younger.
        Am J Sports Med. 2016; 44: 384-392
        • Beischer S.
        • Senorski E.H.
        • Thomeé C.
        • Samuelsson K.
        • Thomeé R.
        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
        • Astur D.C.
        • Cachoeira C.M.
        • da Silva Vieira T.
        • Debieux P.
        • Kaleka C.C.
        • Cohen M.
        Increased incidence of anterior cruciate ligament revision surgery in paediatric verses adult population.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 1362-1366
        • Wiggins A.J.
        • Grandhi R.K.
        • Schneider D.K.
        • Stanfield D.
        • Webster K.E.
        • Myer G.D.
        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
        • Ardern C.L.
        • Ekås G.
        • Grindem H.
        • Moksnes H.
        • Anderson A.
        • Chotel F.
        • et al.
        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
        • Kay J.
        • Memon M.
        • Marx R.G.
        • Peterson D.
        • Simunovic N.
        • Ayeni O.R.
        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
        • Biau D.J.
        • Tournoux C.
        • Katsahian S.
        • Schranz P.J.
        • Nizard R.S.
        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
        • Laboute E.
        • James-Belin E.
        • Puig P.L.
        • Trouve P.
        • Verhaeghe E.
        Graft failure is more frequent after hamstring than patellar tendon autograft.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 3537-3546
        • Lai C.C.H.
        • Ardern C.L.
        • Feller J.A.
        • Webster K.E.
        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
        • Persson A.
        • Fjeldsgaard K.
        • Gjertsen J.-E.
        • Kjellsen A.B.
        • Engebretsen L.
        • Hole R.M.
        • et al.
        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
      2. Prentice HA, Lind M, Mouton C, Persson A, Magnusson H, Gabr A, Seil R, et al. Patient; 2018.

        • Tjong V.K.
        • Murnaghan M.L.
        • Nyhof-Young J.M.
        • Ogilvie-Harris D.J.
        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