Knee function 30 years after ACL reconstruction: a case series of 60 patients

Background: Anterior cruciate ligament (ACL) injury in National Basketball Association (NBA) players can have a significant impact on player longevity and performance. Current literature reports a high rate of return to play, but there are limited data on performance after ACL reconstruction (ACLR). Purpose/Hypothesis: To determine return to play and player performance in the first and second seasons after ACLR in NBA players. We hypothesized that players would return at a high rate. However, we also hypothesized that performance in the first season after ACLR would be worse as compared with the preinjury performance, with a return to baseline by postoperative year 2. Study Design: Case series; Level of evidence, 4. Methods: An online database of NBA athlete injuries between 2010 and 2019 was queried using the term ACL reconstruction. For the included players, the following data were recorded: name; age at injury; position; height, weight, and body mass index; handedness; NBA experience; dates of injury, surgery, and return; knee affected; and postoperative seasons played. Regular season statistics for 1 preinjury season and 2 postoperative seasons were compiled and included games started and played, minutes played, and player efficiency rating. Kaplan-Meier survivorship plots were computed for athlete return-to-play and retirement endpoints. Results: A total of 26 athletes underwent ACLR; of these, 84% (95% CI, 63.9%-95.5%) returned to play at a mean 372.5 days (95% CI, 323.5-421.5 days) after surgery. Career length after injury was a mean of 3.36 seasons (95% CI, 2.27-4.45 seasons). Factors that contributed to an increased probability of return to play included younger age at injury (odds ratio, 0.71 [95% CI, 0.47-0.92]; P = .0337) and fewer years of experience in the NBA before injury (odds ratio, 0.70 [95% CI, 0.45-0.93]; P = .0335). Postoperatively, athletes played a significantly lower percentage of total games in the first season (48.4%; P = .0004) and second season (62.1%; P = .0067) as compared with the preinjury season (78.5%). Player efficiency rating in the first season was 19.3% less than that in the preinjury season ( P = .0056). Performance in the second postoperative season was not significantly different versus preinjury. Conclusion: NBA players have a high rate of RTP after ACLR. However, it may take longer than a single season for elite NBA athletes to return to their full preinjury performance. Younger players and those with less NBA experience returned at higher rates.

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Confirming Proper Button Deployment of Suspensory Fixation During ACL Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120974349 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097434

Author(s):

Daniel F. O’Brien ◽

Lilah Fones ◽

Victoria Stoj ◽

Cory Edgar ◽

Katherine Coyner ◽

...

Keyword(s):

Soft Tissue ◽

Acl Reconstruction ◽

Sports Medicine ◽

Cruciate Ligament ◽

Case Series ◽

Graft Fixation ◽

Level Of Evidence ◽

Lateral Cortex ◽

Suture Button ◽

Suspensory Fixation

Background: Suspensory fixation of anterior cruciate ligament (ACL) reconstruction (ACLR) grafts has emerged as a popular device for femoral graft fixation. However, improper deployment of the suspensory fixation can compromise proper graft tensioning, leading to failure and revision. Also, soft tissue interposition between the button and bone has been associated with graft migration and pain, occasionally requiring revision surgery. Many surgeons rely on manual testing and application of distal tension to the graft to confirm proper button deployment on the lateral cortex of the femur for ACL graft fixation. Purpose: To determine the reliability of the manual resistance maneuver when applying distal tension to deploy the suspensory device along the lateral cortex of the femur. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing ACLR with a suture button suspensory device for femoral fixation were eligible for enrollment in the study. The surgeries were performed by 3 board-certified, sports medicine fellowship–trained orthopaedic surgeons at a single outpatient surgical center between May 2018 and June 2019. All grafts were passed in a retrograde manner into the femoral tunnel, and a vigorous manual tensioning maneuver in a distal direction was placed on the graft to deploy and secure along the lateral cortex of the femur. Intraoperative mini c-arm fluoroscopy was obtained to demonstrate proper suture button positioning. If interposing tissue or an improperly flipped button was identified, rectifying steps were undertaken and recorded. Results: A total of 51 patients with a mean age of 33.3 years were included in the study. Of these patients, 74.5% had normal suture button positioning identified via intraoperative fluoroscopic imaging, while 15.7% had interposed soft tissue and 9.8% had an improperly flipped button. In all cases, the surgeon was able to rectify the malpositioning intraoperatively. Conclusion: Despite the manual sensation of proper suspensory button positioning, intraoperative fluoroscopy identified suture button deployment errors in ACLR 25% of the time. Correcting the malpositioning is not technically demanding. These findings advocate for routine intraoperative surveillance to confirm appropriate suture button seating during ACLR.

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Twenty-Year Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospectively Collected Data

The American Journal of Sports Medicine ◽

10.1177/03635465211027302 ◽

2021 ◽

pp. 036354652110273

Author(s):

Joshua S. Everhart ◽

Sercan Yalcin ◽

Kurt P. Spindler

Keyword(s):

Systematic Review ◽

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Knee Function ◽

Increased Risk ◽

Patient Reported ◽

The Mean ◽

Anterior Cruciate

Background: Several long-term (≥20 years) follow-up studies after anterior cruciate ligament (ACL) reconstruction have been published in recent years, allowing for a systematic evaluation of outcomes. Purpose: To summarize outcomes at ≥20 years after ACL reconstruction and identify patient and surgical factors that affect these results. Study Design: Systematic review; Level of evidence, 4. Methods: Prospective studies of primary ACL reconstructions with hamstring or bone–patellar tendon—bone (BTB) autograft via an arthroscopic or a mini-open technique and with a mean follow-up of ≥20 years were identified. When possible, the mean scores for each outcome measure were calculated. Factors identified in individual studies as predictive of outcomes were described. Results: Five studies met the inclusion and exclusion criteria with a total of 2012 patients. The pooled mean follow-up for patient-reported outcome measures was 44.2% (range, 29.6%-92.7%) and in-person evaluation was 33.2% (range, 29.6%-48.9%). Four studies (n = 584) reported graft tears at a mean rate of 11.8% (range, 2%-18.5%) and 4 studies (n = 773) reported a contralateral ACL injury rate of 12.2% (range, 5.8%-30%). Repeat non-ACL arthroscopic surgery (4 studies; n = 177) to the ipsilateral knee occurred in 10.4% (range, 9.5%-18.3%) and knee arthroplasty (1 study; n = 217) in 5%. The pooled mean of the International Knee Documentation Committee subjective knee function (IKDC) score was 79.1 (SD, 21.8 [3 studies; n = 644]). In 2 studies (n?= 221), 57.5% of patients continued to participate in strenuous activities. The IKDC-objective score was normal or nearly normal in 82.3% (n = 496; 3 studies), with low rates of clinically significant residual laxity. Moderate-severe radiographic osteoarthritis (OA) (IKDC grade C or D) was present in 25.9% of patients (n = 605; 3 studies). Medial meniscectomy is associated with increased risk of radiographic OA. Radiographic OA severity is associated with worse patient-reported knee function, but the association with knee pain is unclear. Conclusion: Currently available prospective evidence for ACL reconstruction with hamstring or BTB autograft provides several insights into outcomes at 20 years. The rates of follow-up at 20 years range from 30% to 93%. IKDC-objective scores were normal or nearly normal in 82% and the mean IKDC-subjective score was 79 points.

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Combined Intra- and Extra-Articular Technique in Revision Anterior Cruciate Ligament Reconstruction

Joints ◽

10.1055/s-0037-1605590 ◽

2017 ◽

Vol 05 (03) ◽

pp. 156-163 ◽

Cited By ~ 4

Author(s):

Jessica Zanovello ◽

Federica Rosso ◽

Alessandro Bistolfi ◽

Roberto Rossi ◽

Filippo Castoldi

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Case Series ◽

Return To Sport ◽

Surgical Removal ◽

Level Of Evidence ◽

Anterior Cruciate ◽

Over The Top

Purpose The aim of the study was to evaluate the “over the top” (OTT) nonanatomical technique for revision of anterior cruciate ligament (ACL) reconstruction. Methods Twenty-four patients with a mean age of 31.9 ± 11.2 years underwent revision of ACL reconstruction using OTT technique. International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, Tegner score, Subjective Patient Outcome for Return to Sport (SPORTS) score, Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale, and KT-1000 evaluation were recorded at a mean follow-up of 30.7 ± 18.9 months. Results Postoperatively, the IKDC objective total score significantly improved (p = 0.0046). The KOOS, Lysholm, and Tegner scores also improved, but the results were not statistically significant (62.4 vs. 72.6, 6.5 vs. 75.8, and 4.1 vs. 6.0, respectively). The subjective IKDC evaluation score improved from an average of 51.1 points to 63.7 points at the last follow-up (p = 0.0027). The RTP prevalence was 81.8%, with 44.4% of the patients returning to the same preinjury level. According to the SPORTS score, 16.6% of patients played sport without limitations in activity and performance. The average ACL-RSI score was 52.1 ± 27.0. No major complications were reported. A total of 21.5% of patients underwent surgical removal of staples. The failure prevalence was 14.3% and the cumulative survivorship, calculated using the Kaplan–Meier method, was equal to 70% at 60 months of follow-up. Conclusion The OTT technique in the revision ACL reconstruction provided improvement in objective and subjective scores, good RTP prevalence, and acceptable rate of complication and failure. One of the advantages was the possibility to avoid the femoral tunnel. Level of Evidence Level IV, therapeutic case series.

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The 90-day Readmission Rate after Single-Bundle ACL Reconstruction Plus LET: Analysis of 2,559 Consecutive Cases from a Single Institution

The Journal of Knee Surgery ◽

10.1055/s-0039-3402794 ◽

2020 ◽

Cited By ~ 2

Author(s):

Alberto Grassi ◽

Giuseppe Gianluca Costa ◽

Sergio Cialdella ◽

Mirco Lo Presti ◽

Maria Pia Neri ◽

...

Keyword(s):

Acl Reconstruction ◽

Readmission Rate ◽

Significant Risk ◽

Case Series ◽

Single Bundle ◽

Female Patients ◽

Case Series Study ◽

Increased Risk ◽

Early Readmission ◽

Over The Top

AbstractThe aim of the present study is to examine the readmission rate within 90 days of a cohort of patients, who underwent an arthroscopic anterior cruciate ligament (ACL) reconstruction with a lateral extraarticular tenodesis, from a single highly specialized sports traumatology department. From our institutional database, we identified 2,559 patients (78.5% males and 21.5% females, with a mean age at surgery of 30.9 ± 11.5 years) who underwent primary ACL reconstruction with the same “over-the-top” technique plus lateral extraarticular tenodesis (LET) from January 2010 to December 2017. From this count, we extracted all patients who were readmitted within 90 days and focused on causes of readmission and reoperation rate. Moreover, a multivariate logistic regression was performed to identify possible variables, such as gender, age, and concomitant meniscus surgery, which could predict the risk of early readmission. From the aforementioned cohort, 58 patients (2.27%) were readmitted within 90 days from surgery after a mean time of 31 ± 23 days. The most common cause of readmission was fever and knee swelling (0.78%), followed by superficial infection (0.63%), deep infection (0.55%), and joint stiffness (0.23%). The patients' age and meniscal lesions requiring concomitant arthroscopic treatment were found to be correlated to an increased risk of early readmission. Superficial infections were more common in female patients (odds ratio [OR] = 3.01), whereas the meniscal treatment was also a significant risk factor specifically for deep infections (OR = 3.56). In conclusion, this technique of arthroscopic ACL reconstruction with LET showed a low readmission rate within 90 days from surgery. However, patients and physicians should be aware of the risk of serious complications, such as deep and superficial infections, mostly in female patients and in cases of concurrent meniscal treatments. This is a Level IV, retrospective case series study.

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ACL Reconstruction Using Autologous Hamstrings Augmented With the Ligament Augmentation and Reconstruction System Provides Good Clinical Scores, High Levels of Satisfaction and Return to Sport, and a Low Retear Rate at 2 Years

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119879079 ◽

2019 ◽

Vol 7 (10) ◽

pp. 232596711987907

Author(s):

Jay R. Ebert ◽

Peter T. Annear

Keyword(s):

Acl Reconstruction ◽

Case Series ◽

Return To Sport ◽

Single Bundle ◽

Hop Tests ◽

Clinical Scores ◽

Ligament Augmentation ◽

Surgical Methods ◽

Patient Reported ◽

Kt 1000

Background: There are a number of surgical methods for undertaking anterior cruciate ligament (ACL) reconstruction (ACLR), although relatively high rates of ipsilateral retears and contralateral tears exist, with only 65% of patients returning to their preinjury level of sport. ACLR techniques adopting synthetic augmentation have been proposed in an attempt to improve clinical outcomes and reduce reinjury rates. Purpose: To determine the efficacy of ACLR using autologous hamstrings augmented with the Ligament Augmentation and Reconstruction System (LARS). Study Design: Case series; Level of evidence, 4. Methods: A total of 65 patients were prospectively treated with arthroscopically assisted single-bundle ACLR using hamstrings augmented with the LARS, of whom 50 were available for 1- and 2-year reviews. Patient-reported outcome measures (PROMs), KT-1000 arthrometer testing, knee range of motion, peak isokinetic knee strength testing, and a battery of 4 hop tests were employed. Limb symmetry indices (LSIs) were calculated. Analysis of variance was used to evaluate differences over time and between limbs. Data on return to the preinjury level of sport, retears, and reoperations were collected. Results: High PROM scores were demonstrated at 1 and 2 years. Before the injury, 47 patients (94%) were actively participating in level 1 or 2 sports, with 38 (76%) and 43 (86%) patients having returned at 1 and 2 years, respectively. Normal (<3 mm; 90%) or nearly normal (3-5 mm; 10%) KT-1000 arthrometer side-to-side differences were observed at 2 years. Apart from knee flexion ( P < .0001), extension ( P = .001), and the 6-m timed hop ( P = .039), there were no between-limb differences at 1 year, and there were no differences on any objective measures at 2 years (all P > .05). Mean LSIs across all measures were ≥90%. At 2 years, 84% to 90% of patients were ≥90% on the hop tests, with 72% and 76% of patients having ≥90% for extension and flexion strength, respectively. Two reoperations were undertaken for meniscal tears (7 and 8.5 months), 1 patient (2%) suffered a retear at 7 months, and 2 patients (3%) suffered a contralateral tear (8 and 12 months). Conclusion: This augmented ACLR technique demonstrated good clinical scores, a high rate of return to sport, and low rates of secondary ruptures and contralateral ACL tears at 2 years. Some caution should be noted in interpreting these results, as 15 of 65 patients (23%) were not included in the 2-year follow-up.

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Risk of Secondary ACL Injury in Adolescents Prescribed Functional Bracing After ACL Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119879880 ◽

2019 ◽

Vol 7 (11) ◽

pp. 232596711987988

Author(s):

Gabriel S. Perrone ◽

Kate E. Webster ◽

Chris Imbriaco ◽

Gabriela M. Portilla ◽

Amishi Vairagade ◽

...

Keyword(s):

Acl Reconstruction ◽

Case Series ◽

Acl Injury ◽

High Rate ◽

Control Group ◽

Acl Injuries ◽

Injury Rates ◽

Increased Risk ◽

Early Graft ◽

Retear Rate

Background: There is a high incidence of a secondary anterior cruciate ligament (ACL) injury in unbraced adolescent athletes. Little is known about the effect of functional bracing with regard to the risk of secondary ACL injuries among adolescents. Hypothesis: Our primary hypothesis was that adolescents would have a high rate of secondary ACL injury even with brace use. A secondary hypothesis was that the reinjury rate with brace use would be lower than that of a historical control group of unbraced patients. Study Design: Case series; Level of evidence, 4. Methods: A group of 219 patients (age <20 years at surgery) who underwent ACL reconstruction and were prescribed postoperative functional bracing during cutting and pivoting sports for 2 years after surgery completed a survey regarding reinjury to either knee. Rates of knee injuries following ACL reconstruction were calculated and compared with those reported in a similar unbraced cohort. The effect of demographic and anatomic factors on risk of secondary ACL injuries was also investigated. Results: The overall follow-up rate was 65% (142/219) at a mean 5.6 years after surgery. In the braced cohort, the overall graft retear rate was 10%, with the highest retear rates observed in male patients 17 years of age and younger (18%). The overall contralateral ACL injury and combined (graft or contralateral ACL) secondary injury rates were 13% and 23%, respectively, with female patients younger than 18 years having the highest contralateral and combined injury rates (17% and 26%, respectively). Younger age (odds ratio [OR], 0.70; P = .021), family history of ACL injury (OR, 2.81; P = .015), and higher lateral tibial slope (OR, 1.25; P = .016) were associated with increased risk of secondary knee injury in the braced cohort. Compared with the unbraced cohort, the braced cohort had a lower overall graft retear rate ( P = .028), a lower graft retear rate in patients younger than 18 years ( P = .012), lower early graft retear rate (within the first year after surgery) ( P = .011), and lower early graft retear rate in subjects younger than 18 years ( P = .003). Conclusion: Postoperative use of functional bracing can result in reduced risk of graft retear and no change in contralateral injury rates. Clinicians may want to consider the use of postoperative functional bracing in adolescent patients.

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Impact of a Standardized Multimodal Analgesia Protocol on Opioid Prescriptions After Common Arthroscopic Procedures

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119870753 ◽

2019 ◽

Vol 7 (9) ◽

pp. 232596711987075 ◽

Cited By ~ 3

Author(s):

Christina J. Hajewski ◽

Robert W. Westermann ◽

Andrew Holte ◽

Alan Shamrock ◽

Matthew Bollier ◽

...

Keyword(s):

Side Effects ◽

Pain Relief ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Case Series ◽

Multimodal Analgesia ◽

Pain Medication ◽

Time Of Surgery ◽

Significant Difference ◽

Arthroscopic Procedures

Background: Excessive prescription of opioids has become a national problem. Providers must attempt to decrease the amount of opioids prescribed while still providing patients with adequate pain relief after surgery. Hypothesis: Implementing a standardized multimodal analgesic protocol will decrease the amount of opioids prescribed at the time of surgery as well as the total amount of opioids dispensed postoperatively. Study Design: Case series; Level of evidence, 4. Methods: Patients who had undergone meniscectomy, rotator cuff repair (RCR), or anterior cruciate ligament (ACL) reconstruction at our institution were identified by Current Procedural Terminology code 12 months prior to and 6 months after the initiation of a standardized multimodal postoperative pain protocol. Records were reviewed to extract demographic data, amount of opioids prescribed at the time of surgery, amount and frequency of opioid refills, and call-ins regarding pain medication or its side effects. A Wilcoxon rank-sum test was used to evaluate differences in opioid prescriptions between pre- and postprotocol, and significance was set to P < .05. Results: The mean amount of opioids prescribed at the time of surgery decreased from 63.5 to 22.3 pills ( P < .0001) for meniscectomy, from 73.3 to 39.7 ( P < .0001) for ACL reconstruction, and from 75.6 to 39.8 ( P < .0001) for RCR. The percentage of patients receiving a refill of opioids during the postoperative period also decreased for all groups: from 13% to 4% ( P = .0051) for meniscectomy, 29.2% to 11.4% ( P = .0005) for ACL reconstruction, and 47.3% to 24.4% ( P < .0001) for RCR. There was no significant difference in patient calls regarding pain medication or its side effects. Conclusion: Institution of a standardized multimodal analgesia protocol significantly decreased the amount of opioids dispensed after common arthroscopic procedures. This reduction in the amount of opioids given on the day of surgery did not result in an increased demand for refills. Our study also demonstrated that 20 opioid pills were adequate for patients undergoing meniscectomy and 40 pills were adequate for ACL reconstruction and RCR in the majority of cases. This protocol serves as a way for providers to decrease the amount of opioids dispensed after surgery while providing patients with alternatives for pain relief.

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Is the Independent Tape Reinforcement a valid technique to reduce the rerupture rate of ACL reconstructions? A technical instruction and case series with 2-year follow up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00308 ◽

2020 ◽

Vol 8 (5_suppl4) ◽

pp. 2325967120S0030

Author(s):

Stefan Schneider ◽

René Kaiser ◽

Ansgar Ilg ◽

Johannes Holz

Keyword(s):

Acl Reconstruction ◽

Case Series ◽

Technical Instruction ◽

Clinical Instability ◽

Internal Bracing ◽

Internal Brace ◽

Prospective Case Series ◽

One Year ◽

A Minor ◽

Proprioceptive Function

Aims and Objectives: Although there is an ongoing development in ACL reconstruction techniques, a rerupture rate up to 20% still is discussed in the literature. Is the ACL reconstruction using a quadriple semitendinosus in combination with a polyurethane tape reinforcement a valid technique to reduce the retare rate? A clinical trial with 35 Patients compared to 320 patients using an isolated semitendinosus reconstruction without internal bracing. Materials and Methods: Additionally, to the quadruple semitendinosus technique with cortical button fixation, the transplant is parallelly stabilized by a polyurethane tape which is individually fixed in the femoral button. The tape secures the transplant during the remodeling episode since repeated small tensions on the transplant during this time are discussed as a reason for a rerupture. In this prospective case series 35 patients were treated with this technique, reexamined and VAS, Tegner, KOOS Jr. and SANE are preoperatively, two and six weeks, three and six month and after one, two and five years recorded using a PROMS system. Clinical instability and proprioceptive function were also surveyed at these timepoints. The results and rerupture rates were compared with 320 patients of our database who underwent a comparable reconstruction without using the internal brace. Patients with fractures and multi-ligament injuries were excluded. Results: Until now no reruptures were reported, there are no significant subjective or objective differences compared to the group without internal bracing. The two years results are pending. Preoperatively the VAS score was 2.2 +/- 2.0. Two weeks after the surgery 2.1 +/- 1.8 and one year postoperatively 0.5 +/- 0.7. Tegner score preoperatively: 4.6 +/- 2.7 after one year 4.7 +/- 3.0. KOOS jun. improves in both groups around 15%. Conclusion: Until now the ACL reconstruction using an internal brace seems to be a safe and effective technique. Biomechanical studies show beneficial stabilizing results and a minor rerupture rate might be possible due to reduced microlesions during the remodeling period. The study is still ongoing, longtime results are pending.

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Knee Pathology in Young Adults After Pediatric Anterior Cruciate Ligament Injury: A Prospective Case Series of 47 Patients With a Mean 9.5-Year Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546519837935 ◽

2019 ◽

Vol 47 (7) ◽

pp. 1557-1566 ◽

Cited By ~ 7

Author(s):

Guri Ranum Ekås ◽

Marit Mjelde Laane ◽

Arne Larmo ◽

Håvard Moksnes ◽

Hege Grindem ◽

...

Keyword(s):

Young Adults ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Knee Injuries ◽

Case Series ◽

Acl Injury ◽

Meniscal Tears ◽

Leg Length ◽

Cartilage Injuries

Background: The rate of secondary knee injuries after pediatric anterior cruciate ligament (ACL) injury is uncertain, and previous studies are limited because of poor methodology. Purpose: To evaluate the incidence of new meniscal injuries since the initial diagnostic magnetic resonance imaging (MRI) of young adults who sustained a pediatric ACL injury. In addition, to evaluate meniscal and cartilage injuries in the index knee and contralateral knee injuries on MRI at final follow-up (9.5 years). Furthermore, to assess leg length and alignment based on long-leg radiographs. Study Design: Case series; Level of evidence, 4. Methods: Study population at final follow-up included 47 young adults who sustained a pediatric ACL injury before age 13 years. They were followed prospectively since the time of injury for a mean 9.5 years at final follow-up. Imaging included diagnostic MRI of the index knee and 3.0-T MRI of both knees at 1-, 2-, and 9.5-year follow-up, in addition to long-leg radiographs at final follow-up. Forty-three patients underwent active rehabilitation without ACL reconstruction initially; 4 were treated with initial ACL reconstruction. At final follow-up, 27 (57%) had undergone ACL reconstruction. Results: Fourteen patients had meniscal tears in the index knee at final follow-up (prevalence, 30%). The majority of these were in the same location as previously repaired tears (n = 9). Between diagnostic MRI and final follow-up, 16 patients had sustained new meniscal tears to a healthy meniscus (incidence, 34%). At final follow-up, meniscal injuries recorded at baseline or during follow-up were no longer visible and appeared healed in 17 patients (20 tears). MRI at final follow-up showed cartilage injuries in the index knee of 13 patients (28%) and contralateral injuries in 8 patients (meniscus, n = 2; cartilage, n = 5; subchondral fracture, n = 1). Two patients had a leg-length difference >15 mm, and 3 had side-to-side difference in knee alignment >5°. Conclusion: The incidence of new meniscal tears after pediatric ACL injury was 34% during a mean follow-up period of 9.5 years. At final follow-up, 27 patients (57%) had normal menisci, and none had developed knee osteoarthritis. Primary active rehabilitation, close follow-up, and delayed surgery if needed may be a viable and safe treatment option for some pediatric ACL injuries.

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