Similar outcomes after anterior cruciate ligament reconstruction in paediatric and adult populations: a 1‐year follow‐up of 506 paediatric operations in Denmark

Self Cite

PurposeTo assess children's physical function and subjective knee status 1 and 3 years after anterior cruciate ligament (ACL) reconstruction. It was hypothesised that there was no difference between the operated and normal legs in relation to physical strength and function, that there was <‐2 mm side‐to‐side difference in knee laxity, and that the subjective knee function was better 3 years after ACL reconstruction compared to 1 year after.MethodsChildren (<16 years of age) who had an ACL reconstruction had follow‐up with physical function tests (four hop tests and strength measurement in a power rig [PR]), anterior knee laxity (measured using a Rolimeter) and patient‐reported outcome measures (Pedi‐International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]‐Child) 1 and 3 years postoperatively. Changes from 1‐ to 3‐year follow‐up were evaluated with a paired t test.ResultsOut of 148 ACL reconstructed children, 60 had all measures. The four hop tests and the PR all yielded a Limb Symmetry Index >90% at both follow‐ups. There was a significant improvement from 1‐ to 3‐year follow‐up in two‐hop tests (6 m on time and crossover hop). Side‐to‐side knee laxity was >2 mm in four children at 1‐ and 3‐year tests. Pedi‐IKDC scores increased, and KOOS‐Child improved significantly from 1 to 3 years in two of the five domains: ‘Sport’ and ‘Quality of life’, but scores were lower than in a cohort of normal children.ConclusionThe children had good objective physical function 1 and 3 years after ACL reconstruction. However, scores from the KOOS‐Child sport‐specific function and quality of life domains were lower than in normal children.Level of evidenceLevel II.

Section: Patient-reported Outcomesmentioning

confidence: 99%

Section: Patient-reported Outcomesmentioning

confidence: 99%

Section: Patient-reported Outcomesmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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Good physical function but reduced quality of life in children 3 years after ACL reconstruction

Lundgaard‐Nielsen,

Herzog,

Warming

et al. 2024

Self Cite

“…As the number of primary ACLRs performed increases in this population, it is expected that so will the number of revision ACLRs (r-ACLR) [3]. In addition, primary ACLR procedures have been shown to result in higher rates of revision in children and adolescents compared to adults [4].…”

Section: Introductionmentioning

confidence: 99%

Approximately half of pediatric or adolescent patients undergoing revision anterior cruciate ligament reconstruction return to the same level of sport or higher: A systematic review

Sun,

Vivekanantha,

Khalik

et al. 2024

PurposeTo summarise the surgical techniques and clinical outcomes in paediatric and adolescent patients undergoing revision anterior cruciate ligament reconstruction (r‐ACLR).MethodsThree databases (MEDLINE, PubMed and EMBASE) were searched from inception to 29 July 2023. The authors adhered to the PRISMA and R‐AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, surgical details, patient‐reported outcome measures (PROMs), rates of instability, rupture and return to sport (RTS) were extracted.ResultsEight studies comprising 706 (711 knees) patients were included (48.7% female). The mean age at r‐ACLR was 17.1 years (range: 16.5–18.0). Autografts (67.5%) were more common than allografts (32.2%) in revision, with bone‐patellar tendon‐bone (BPTB) being the most prevalent autograft source (59.6%). Bone grafts were used in seven patients (4.8% of 146 patients). The most common femoral and tibial fixation techniques were interference screws (37.6% and 38.1%, of 244 patients, respectively). The most common tunnelling strategy was anatomic (69.1% of 236 patients), and meniscus repairs were performed in 39.7% of 256 patients. The re‐rupture rate was 13.0% in 293 patients. RTS at the same level or higher was 51.6% in 219 patients. The mean (SD) Lysholm score was 88.1 (12.9) in 78 patients, the mean (SD) Tegner score was 6.0 (1.6) in 78 patients, and the mean (SD) IKDC score was 82.6 (16.0) in 126 patients.ConclusionR‐ACLR in paediatric and adolescent patients predominantly uses BPTB autografts and interference screw femoral and tibial fixation with concomitant meniscal procedures. Rates of re‐rupture and RTS at the same level or higher were 13.0% and 51.6%, respectively. Information from this review can provide orthopaedic surgeons with a comprehensive understanding of the most commonly used operative techniques and their outcomes for revision ACLR in this population.Level of Evidence: Level IV.

Similar two‐year improvement in patient‐reported outcomes in patients 40 years and older with outerbridge grade III and IV lesions following ACL reconstruction

Kleinsmith,

Doxey,

Puckett

et al. 2024

PurposeThis study aims to evaluate clinical and patient‐reported outcome measures (PROMs) of patients 40 years and older that underwent anterior cruciate ligament reconstruction (ACLR) and determine the influence of preexisting arthritis and chondral wear on ACLR outcomes. We hypothesized that patients aged 40+ with ACLR would have excellent clinical outcomes and PROMs regardless of preexisting arthritic changes.MethodsA total of 118 patients were included. Patients aged 40 years and older who underwent ACLR in a single healthcare system between 2009 and 2016 were eligible. Outcomes assessed include Knee Injury and Osteoarthritis Outcome Scores (KOOS), Single Assessment Numeric Evaluation (SANE) scores, intraoperative Outerbridge grading, preoperative Kellgren–Lawrence (KL) grading and postoperative complication rates over a 2‐year period.ResultsAverage increase in KOOS and SANE scores were 21.2 19.9 and 23.5 31.3, respectively. Patients with Outerbridge grade III and IV lesions in weight‐bearing compartments had lower baseline SANE and KOOS scores than those without (47.1 ± 22.0 vs. 64.5 ± 23.6 baseline SANE and 43.1 ± 18.1 vs. 63.5 ± 15.9 baseline KOOS; p = 0.002 and p < 0.001, respectively) with no significant difference in the amount of change in SANE or KOOS scores (p = 0.111 and p = 0.165 respectively). Patients with KL‐grade 2+ osteoarthritis experienced similar changes in KOOS and SANE over the 2‐year period to their counterparts (p = 0.598 and p = 0.643, respectively).ConclusionThere is no correlation between preexisting osteoarthritic changes or chondral defects and PROs. KOOS and SANE scores both increased postoperatively. When treating older patients with an ACL tear, surgeons should consider the activity level and desires of the patient as they determine appropriate treatment. Preexisting osteoarthritis does not correlate with patient‐reported outcomes for ACLR.Level of EvidenceLevel IV