Fifteen-Year Survival of Endoscopic Anterior Cruciate Ligament Reconstruction in Patients Aged 18 Years and Younger

Pinczewski, Leo A.; Morgan, Matthew B.; Salmon, Lucy J.; Waller, Alison; Thompson, S.M.; Roe, Justin

doi:10.1177/0363546515623032

Cited by 147 publications

(155 citation statements)

References 40 publications

(59 reference statements)

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“…Perhaps this is not surprising since the average age of the patient group at follow-up was relatively young at 22 years. This is consistent with the findings of Morgan et al, 10 who also reported that 66% of their younger patient cohort were participating in strenuous or very strenuous sports at 15 years postsurgery. While not statistically significant, patients who rated their ability to perform as similar to before injury were more likely to still be playing their preinjury sport.…”

Section: Discussionsupporting

confidence: 92%

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Return to Sport in the Younger Patient With Anterior Cruciate Ligament Reconstruction

Webster

Feller

Whitehead

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Although anterior cruciate ligament (ACL) reconstruction is generally regarded as a successful procedure, only 65% of patients return to their preinjury sport. While return-to-sport rates are likely higher in younger patients, there is a paucity of data that focus on the younger patient and their return-to-sport experience after ACL reconstruction.Purpose:To investigate a range of return-to-sport outcomes in younger athletes who had undergone ACL reconstruction surgery.Study Design:Case series; Level of evidence, 4.Methods:A group of 140 young patients (<20 years old at surgery) who had 1 ACL reconstruction and no subsequent ACL injuries completed a survey regarding details of their sport participation at a mean follow-up of 5 years (range, 3-7 years).Results:Overall, 76% (95% CI, 69%-83%) of the young patient group returned to the same preinjury sport. Return rates were higher for males than females (81% vs 71%, respectively; P > .05). Of those who returned to their sport, 65% reported that they could perform as well as before the ACL injury and 66% were still currently participating in their respective sport. Young athletes who never returned to sport cited fear of a new injury (37%) or study/work commitments (30%) as the primary reasons for dropout. For those who had successfully returned to their preinjury sport but subsequently stopped participating, the most common reason cited for stopping was study/work commitments (53%). At a mean 5-year follow-up, 48% of female patients were still participating in level I (jumping, hard pivoting) sports, as were 54% of males.Conclusion:A high percentage of younger patients return to their preinjury sport after ACL reconstruction surgery. For patients in this cohort who had not sustained a second ACL injury, the majority continue to participate and are satisfied with their performance.

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Section: Discussionsupporting

confidence: 92%

“…A more recent study by Morgan et al 10 showed that 69% of their young patient cohort (<18 years old at surgery) were able to return to preinjury level of sport. Overall, there are limited data available that specifically focus on return-to-sport rates in the younger ACL-reconstructed athlete, and the existing results are mixed.…”

mentioning

confidence: 98%

Return to Sport in the Younger Patient With Anterior Cruciate Ligament Reconstruction

Webster

Feller

Whitehead

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…[2] Long-term follow-ups of 10 years or more have reported second injury rates between 23% and 27%. [3–5] Several factors have been implicated in second ACL injury risk, including graft placement,[6–8] graft type,[9–13] sex,[14–16] age,[5, 14, 17–19] time from surgery,[10, 20, 21] activity level,[22, 23] and aberrant neuromuscular and biomechanical adaptations. [24]…”

Section: Introductionmentioning

confidence: 99%

“…[19] Injury rates in this younger cohort have been reported almost as high as 30% in the literature. [5, 17, 20, 24] In addition, the increased risk in this group is apparent immediately upon returning to sports. The evidence strongly indicates that second ACL injury risk is greatest within the first 2 years after ACLR for young athletes returning back to high level sports.…”

Section: Introductionmentioning

confidence: 99%

Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations

2016

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Anterior cruciate ligament (ACL) tears are common knee injuries sustained by athletes during sports participation. A devastating complication of returning to sport following ACL reconstruction (ACLR) is a second ACL injury. Strong evidence now indicates that younger, more active athletes are at particularly high risk for a second ACL injury and this risk is greatest within the first two years following ACLR. Nearly one-third of the younger cohort that resumes sports participation will sustain a second ACL injury within the first two years after ACLR. The evidence indicates that the risk of second injury may abate over this time period. The incidence rate of second injuries in the first year after ACLR is significantly greater than the rate in the second year. The lower relative risk in the second year may be related to athletes achieving baseline joint health and function well after the current expected timeline (6 to 12 months) to be released to unrestricted activity. This highlights a considerable debate in the return to sport decision process as to whether an athlete should wait until two years after ACLR to return to unrestricted, sports activity. In this review, we present evidence in the literature that athletes achieve baseline joint health and function approximately two years after ACLR. We postulate that delay in returning to sports for nearly two years will significantly reduce the incidence of second ACL injuries.

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“…In my experience the majority of revision ACL surgery occurs within the first 5 years. [22][23][24] In bioscrew fixation cases, the surgeon does not encounter healthy bone, rather a partially decomposed bioscrew in soft bone, which is definitely not an advantage in revision surgery.…”

mentioning

confidence: 99%

Editorial Commentary: The Acrid Bioscrew in Anterior Cruciate Ligament Reconstruction of the Knee

Pinczewski

Salmon

2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Bioresorbable screws have been widely adopted for graft fixation in knee anterior cruciate ligament (ACL) reconstruction on the promise of screw resorbtion and replacement by bone. When considering the value of bioresorbable screws, it is imperative to understand that the "A" in PGA and PLA, the base ingredient of all bioscrews, is for Acid. All resorb by a process of hydrolysis; the speed and extent of resorbtion is determined by both the acidity of the screw and the environment in which it is placed. Regrettably, the promise of reliable, predictable screw resorbtion and replacement by bone remains elusive, despite the addition of "osteoconductive" materials. For the most part, bioresorbables are associated with good clinical outcomes for ACL reconstruction; they are not "dangerous," just disappointing with respect to bony replacement. We propose that nonresorbing inert plastics such as PEEK (polyether ether ketone) may be better suited for the purpose of graft fixation devices for ACL reconstruction.

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Fifteen-Year Survival of Endoscopic Anterior Cruciate Ligament Reconstruction in Patients Aged 18 Years and Younger

Abstract: 3Background. Within the young population, the literature examining the short term survival and the variables

Cited by 147 publications

References 40 publications

Return to Sport in the Younger Patient With Anterior Cruciate Ligament Reconstruction

Return to Sport in the Younger Patient With Anterior Cruciate Ligament Reconstruction

Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations

Editorial Commentary: The Acrid Bioscrew in Anterior Cruciate Ligament Reconstruction of the Knee

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