Revision ACL Reconstruction in Skeletally Mature Athletes Younger Than 18 Years

Abstract

Background Young, active, skeletally mature patients have higher failure rates after various surgical procedures, including stabilization for shoulder instability and primary ACL reconstruction. It is unclear whether young, active, skeletally mature patients share similarly high failure rates after revision ACL reconstruction. Questions/purposes We therefore determined whether revision ACL reconstruction restores knee stability and allows young (younger than 18 years), active, skeletally mature patients to return to preinjury activity levels. Patients and MethodsWe retrospectively identified 36 patients who had an initial ACL reconstruction between the ages of 12 and 17 years (mean, 15.4 years) and subsequent revision between the ages of 13 and 18 years (mean, 16.9 years); of these, 2-year followup was available for 21 (75%). Mechanisms of primary graft failure included traumatic rerupture (23 noncontact, seven contact), persistent instability (five), and infection (one). One patient had open physes at the time of revision. All revisions were single-stage transosseous reconstructions. The minimum followup was 24 months (mean, 36 months; range, 24-63 months).

Revision Anterior Cruciate Ligament Reconstruction in Military Personnel

“…However, the overall proportion of the population that can be consid-ered "high-demand" is also relatively small, and our population is commensurate to one of the two similar studies in the literature. 33 Second, as with all studies in military cohorts, there is a risk that our results are not generalizable to the civilian population. In this case, however, we were attempting to determine the results of revision ACL reconstruction in a high-demand population with a limited ability to modify their activity level.…”

“…Reinhardt et al (2012) reported on the results of 21 adolescent patients undergoing revision ACLR with a mean 36 month follow-up. 33 Only 11 of 21 (52%) returned to the same or higher level of competitive sports. In addition, two patients (9.5%) had subjective complaints of knee instability, and two more had required another revision surgery during follow-up.…”

Proximal Tibial Anterior Closing Wedge Osteotomy in Repeat Revision of Anterior Cruciate Ligament Reconstruction

“…However, similar to other published studies published on ACL revision, the functional results remain less favorable than those obtained with primary ACL reconstruction. 17,28,33,42 Revision of the ACL is a complex surgical procedure that may present numerous technical difficulties. The presence of cartilage and meniscal injuries is a likely cause of poorer clinical outcomes as compared with primary ACL reconstruction.…”

Anterior Cruciate Ligament Injuries: Diagnosis, Treatment, and Prevention

“…114 However, only 44% to 62% returned to their previous level of athletic performance. [114][115][116][117][118][119] Female athletes were less likely than male athletes to return to sports after ACL injury or ACL reconstruction. 19,119,120 …”