Paediatric and adolescent anterior cruciate ligament reconstruction surgery

Abstract

Aims Anterior cruciate ligament (ACL) surgery in children and the adolescent population has increased steadily over recent years. We used a national database to look at trends in ACL reconstruction and rates of serious complications, growth disturbance, and revision surgery, over 20 years. Methods All hospital episodes for patients undergoing ACL reconstruction, under the age of 20 years, between 1 April 1997 and 31 March 2017, were extracted by procedure code from the national Hospital Episode Statistics (HES). Population standardized rates of intervention were determined by age group and year of treatment. Subsequent rates of serious complications including reoperation for infection, growth disturbance (osteotomy, epiphysiodesis), revision reconstruction, and/or contralateral ACL reconstruction rates were determined. Results Over the 20 year period, 16,125 ACL reconstructions were included. The mean age of patients was 16.9 years (SD 2.0; 27.1% female, n = 4,374/16,125). The majority of procedures were observed in the 15 to 19 years age group. The rate of ACL reconstruction increased 29-fold from 1997 to 1998, to 2016 to 2017. Within 90 days of ACL reconstruction, the rate of reoperation for infection was 0.31% (95% confidence interval (CI) 0.23 to 0.41, n = 50/16,125) and the rate of pulmonary embolism was 0.037% (95%.CI 0.014 to 0.081, n = 6/16,125). Of those with minimum five-year follow-up following ACL reconstruction (n = 7,585), 1.00% of patients subsequently underwent an osteotomy (95% CI 0.79 to 1.25, n = 76/7,585), 0.09% an epiphysiodesis (95% CI 0.04 to 0.19, n = 7/7,585), 7.46% revision ACL reconstruction (95% CI 6.88 to 8.08, n = 566/7,585), and 6.37% contralateral ACL reconstruction (95% CI 5.83 to 6.94, n = 483/7,585). Conclusion Rates of paediatric and adolescent ACL reconstruction have increased 29-fold over the last 20 years. Despite the increasing rate in the younger population, the risk of serious complications, including further surgery for growth disturbance is very low. The results of our study provide a point of reference for shared decision making in the management of ACL injury in the paediatric and adolescent population. Cite this article: Bone Joint J 2020;102-B(2):239–245.

Anterior Cruciate Ligament Reconstruction and Lateral Plasty in High-Risk Young Adolescents: Revisions, Subjective Evaluation, and the Role of Surgical Timing on Meniscal Preservation

“…In fact, no patients underwent partial epiphysiodesis or realignment osteotomy, an occurrence which has been reported to reach more than 1%. 18 A similar concept of combined intra-articular and extra articular extra-osseous reconstruction has already been employed by Kocher et al 12 using iliotibial band in 237 skeletally immature Tanner 1 or 2 patients, reporting satisfactory outcomes in terms of failure rate (6.6%), subjective scores, and respect of skeletal growth. Both techniques are easy to perform and respectful of immature physis, but the latter allows for increase of the graft size respective to the iliotibial band, which is only minimally affected, reducing the tissue invasively.…”

“…Recent studies from registries and national databases have demonstrated that the rate of anterior cruciate ligament (ACL) ruptures in children and adolescents has increased over the past decade. 18,19 A rapid growth of 15.7% in the 15- to 19-year-old cohort and of 27.6% in the 10- to 14-year-old cohort was in fact reported between 2007 and 2011, 29 and a 29-fold increase was estimated from 1997 to 2017. 18…”

“…18,19 A rapid growth of 15.7% in the 15- to 19-year-old cohort and of 27.6% in the 10- to 14-year-old cohort was in fact reported between 2007 and 2011, 29 and a 29-fold increase was estimated from 1997 to 2017. 18…”

Implementing ACL Injury Prevention in Daily Sports Practice—It’s Not Just the Program: Let’s Build Together, Involve the Context, and Improve the Content

“…Per year, over two million ACL injuries occur worldwide. The majority of these injuries are observed in paediatric and adolescent athletes [6][7][8][9][10], with a higher incidence in girls compared to boys, especially at younger ages [11][12][13]. These ACL injuries lead to the longest withdrawal time from youth sports.…”

Adolescents Have Twice the Revision Rate of Young Adults After ACL Reconstruction With Hamstring Tendon Autograft: A Study From the Swedish National Knee Ligament Registry

“…1,17,28 The incidence of ACL injuries in the pediatric and adolescent population has increased in recent years, due in part to the increase in youth competitive athletic activity with yearround training and competition. 14,20,24,28,39 An ACL rupture is a serious knee injury that may lead to an inability for young individuals to return to sports at their previous recreational or competitive level, despite receiving the best possible treatment. 11,23,38 A rupture of the ACL can lead to functional knee instability, with episodes of giving way when walking or during other everyday activities.…”