More systematic ways to evaluate revision surgery are warranted to treat adolescents with revision ACL reconstruction.
Orthopedics Today, August 2016
Pediatric patients who underwent revision ACL reconstruction experienced suboptimal outcomes, according to recently presented data.
“We found revision [ACL] surgery in children and adolescents was associated with suboptimal patient outcomes, high graft retear rates, high complication and return to OR rates, significant risk of contralateral ACL injury and compromised return to sports rates,” Melissa A. Christino, MD, said in her presentation of the study performed at Boston Children’s Hospital, which won the Richard J. O’Connor Research Award at the Arthroscopy Association of North America Annual Meeting.
Revision ACL reconstruction
Among 88 patients 18 years of age or younger who underwent a total of 90 revision ACL reconstructions, 74.4% experienced additional intra-articular injuries, including meniscal tears or chondral injuries.
“By far, the most common graft used for our revision surgeries was allograft, followed by patellar tendon,” Christino said. “This stands in contrast [to] hamstring being the most popular choice for the primary procedure.”
Christino and her colleagues found a 20% graft re-injury rate, a 25% rate of return to the OR and a 20% contralateral ACL tear rate.
“This [contralateral tear] rate was even higher among those who went on to reinjure their revision graft [33%],” she said.
Results showed a mean pediatric IKDC score of 77.5, a Lysholm score of 79 and a Tegner score of 6.6. These outcome scores are lower than those reported in other studies of similar patient populations undergoing primary ACL reconstruction. Results also showed patient satisfaction was 77.3%.
Returning to sport
“We had a 69% return-to-sport rate, with an average time of 8.9 months,” Christino said. “However, of the patients who did go back to sports, only 55% were able to return to the same level [of competition] and a significant number were unable to return to that same level specifically because of their knee.”
According to Christino, more research is needed on adolescents undergoing revision ACL reconstruction to improve outcomes, including more systematic ways to evaluate revision surgery in a prospective manner.
“Obviously, a lot more research needs to be done in this patient population to find ways to optimize the surgery and improve our results of revision surgery,” Christino told Orthopedics Today. “Young people, especially as [they return to] high activity levels after primary reconstruction [or] revision surgery, place significant physical demands on their reconstructed knee that may differ from adults [undergoing] ACL reconstruction. So it is important to find ways for us to get patients back on the field in a more predictable and safe way to help them achieve their desired performance level.” – by Casey Tingle
- Reference:
- Christino MA, et al. Paper #SS-10. Presented at: Arthroscopy Association of North America Annual Meeting; April 14-16, 2016; Boston.
- For more information:
- Melissa A. Christino, MD, can be reached at Children’s Orthopaedics of Atlanta, 5445 Meridian Mark Rd., Suite 250, Atlanta, GA 30342; email: mchristino@childrensortho.com.
Disclosure: Christino reports no relevant financial disclosures.