Anterior cruciate ligament injuries in children and adolescents: mid-term clinical and functional results and return-to-sports after surgery

Abstract

Introduction

Anterior cruciate ligament (ACL) injuries in children and adolescents have increased in recent years. Controversy remains regarding their clinical and functional results, as well as return-to-sports (RTS) rate. The aim of this work is to analyze the clinical and patient-reported outcomes (PROMs) of ACL reconstruction (ACL-R) and determine which factors are associated with a better med-term outcome.

Methods

63 skeletally immature subjects (64 knees) with ACL injury treated by ligamentoplasty and with at least 2 years of follow-up were included. Demographic data, sports level, initial magnetic resonance imaging (MRI) findings, complications and RTS rate were collected. All the subjects completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala Score, Lysholm Score and Tegner Activity Scale questionnaires.

Results

The mean age at the time of the injury was 13.9 ± 2.3 years and the 66% performed organized sport. All-epiphyseal tunnels were performed in 23% (14% all-inside), and transphyseal tunnels in 73% (57.5% all-inside). The all-inside technique were associated with a higher proportion of grafts obtained with a single hamstring (p < 0.05), without differences in the RTS rate but with lower scores in Lysholm and Tegner scores (p < 0.05). Lateral extra-articular tenodesis (LEAT) was performed in 27% of the cases, showing them an earlier RTS and an even higher level (p < 0.05). After a mean follow-up of 3.2 years (range 2-10.4), the RTS rate is 80% and the mean PROMs are: KOOS 91.2 ± 6.4, Kujala 93.3 ± 5.7, Lysholm 93.2 ± 10.6, and Tegner level 7.7 ± 1.3.

Conclusion

The ACL-R in children and adolescents achieves a high RTS rate and excellent PROMs after a mean follow-up of 3.2 years. All-epiphyseal tunnels achieve similar results to transphyseal but respecting the physis, all-inside technique produces less morbidity with a similar function, and addition of LEAT allows an early RTS with a higher level.